Background: Hospitalists increasingly confront patient care and policy dilemmas due to financial incentives created by bundled payments, single payments that “bundle” acute and post-acute care for specific diagnoses. The most common and most successful bundled payment has been for total joint replacement, where cost savings have been achieved through discharging patients to home rather than [...]

Background: More than 300,000 older adults are hospitalized in the US annually for hip fracture. While operative repair is recommended in most individuals, perioperative complications account for significant morbidity and mortality. Co-management programs for hip fracture care are effective in reducing mortality, as well as in-hospital complications, length of stay (LOS), readmission rate, and cost. [...]

Case Presentation: A 62-year-old woman with a medical history significant for seizure disorder presented with a right tibia fracture following a mechanical fall. She underwent open reduction and internal fixation of the right tibia and was extubated without difficulty following surgery. The following day, she became febrile and hypoxemic, requiring an escalating amount of oxygen [...]

Background: In surgical co-management (SCM), surgeons and hospitalists share responsibility of care of the surgical patients. In August 2012, we implemented SCM in Orthopedic and Neurosurgery services at our institution (Ann Surg 2016;264(2):275-282). This model is innovative because the same Internal Medicine hospitalists are dedicated year round to the same surgical service. After the first [...]

Background: “Hospital at Home” (HaH) models of care have existed for over 20 years in the U.S. More recently, HaH models have evolved to include transitional care solutions to improve patients’ post-acute outcomes. Meanwhile, services which were traditionally provided only in the inpatient setting, such as elective arthroplasty, have begun to shift to same-day and [...]

Case Presentation: After suffering a left-sided middle cerebral artery stroke and subsequent right sided weakness, an 85-year-old female fell and sustained a fracture of her right intertrochanteric femur. She initially had an ORIF at an outside hospital, but this subsequently failed and the patient had continued pain. She had repeat x-ray imaging of her femur [...]

Case Presentation: A 66-year old woman with a history of obesity and hypertension presented with a right femoral neck fracture after a mechanical fall. She underwent a right total hip arthroplasty and the anesthesiologist reported transient intraoperative hypoxia during cement placement. In the recovery room, the patient was hypotensive, tachycardic and hypoxic requiring up to [...]

Case Presentation: A 33 year old previously healthy male with no significant past medical history presented to the ED with two days of severe bilateral shoulder pain and chest swelling, found to have bilateral anterior shoulder dislocations with humerus fractures, an AKI and rhabdomyolysis. Patient stated he awoke from sleep two days prior with severe [...]

Background: Hospitalists increasingly confront patient care and policy dilemmas due to financial incentives created by bundled payments, single payments that “bundle” acute and post-acute care for specific diagnoses. The most common and most successful bundled payment has been for total joint replacement, where cost savings have been achieved through discharging patients to home rather than [...]