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Magnani AS, de Castro LT, Manta ICKA, Dib VG, Vittorelli LO, Portela FSO, Wolosker N, Teivelis MP. Preoperative evaluation profile of patients undergoing arterial vascular surgery in a tertiary hospital. Clinics (Sao Paulo) 2024; 79:100445. [PMID: 39059143 PMCID: PMC11338055 DOI: 10.1016/j.clinsp.2024.100445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 06/02/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Patients with peripheral arterial disease have an increased risk of developing cardiovascular complications in the postoperative period of arterial surgeries known as Major Adverse Cardiac Events (MACE), which includes acute myocardial infarction, heart failure, malignant arrhythmias, and stroke. The preoperative evaluation aims to reduce mortality and the risk of MACE. However, there is no standardized approach to performing them. The aim of this study was to compare the preoperative evaluation conducted by general practitioners with those performed by cardiologists. METHODS This is a retrospective analysis of medical records of patients who underwent elective arterial surgeries from January 2016 to December 2020 at a tertiary hospital in São Paulo, Brazil. The authors compared the preoperative evaluation of these patients according to the initial evaluator (general practitioners vs. cardiologists), assessing patients' clinical factors, mortality, postoperative MACE incidence, rate of requested non-invasive stratification tests, length of hospital stay, among others. RESULTS 281 patients were evaluated: 169 assessed by cardiologists and 112 by general practitioners. Cardiologists requested more non-invasive stratification tests (40.8%) compared to general practitioners (9%) (p < 0.001), with no impact on mortality (8.8% versus 10.7%; p = 0.609) and postoperative MACE incidence (10.6% versus 6.2%; p = 0.209). The total length of hospital stay was longer in the cardiologist group (17.27 versus 11.79 days; p < 0.001). CONCLUSION The increased request for exams didn't have a significant impact on mortality and postoperative MACE incidence, but prolonged the total length of hospital stay. Health managers should consider these findings and ensure appropriate utilization of human and financial resources.
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Affiliation(s)
- Arthur Souza Magnani
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Leandro Teixeira de Castro
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Isabela Cristina Kirnew Abud Manta
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Viviane Galli Dib
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Luiz Otávio Vittorelli
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Felipe Soares Oliveira Portela
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Nelson Wolosker
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Marcelo Passos Teivelis
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Johnson SA, Whipple M, Kendrick DR, Gouttsoul A, Eppich K, Wu C, Rupp AB, Signor EA, Reddy SP. Clinical Outcomes of Orthopedic Surgery Co-Management by Internal Medicine Advanced Practice Clinicians: A Cohort Study. Am J Med 2024:S0002-9343(24)00345-0. [PMID: 38866301 DOI: 10.1016/j.amjmed.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/25/2024] [Accepted: 05/26/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Comanagement of orthopedic surgery patients by internal medicine hospitalists is associated with improvements in clinical outcomes including complications, length of stay, and cost. Clinical outcomes of orthopedic comanagement performed solely by internal medicine advanced practice clinicians have not been reported. Our objecyive was to compare clinical outcomes between advanced practice clinician-based comanagement and usual orthopedic care. METHODS This is a retrospective cohort study in patients 18 years or older, hospitalized for orthopedic joint or spine surgery between May 1, 2014 and January 1, 2022. Outcomes assessed were length of stay, intensive care unit (ICU) transfer, return to operating room, in-hospital and 30-day mortality, 30-day readmission, and total direct cost, excluding surgical implants. Generalized boosted regression and propensity score weighting was used to compare clinical outcomes and health care cost between usual care and advanced practice clinician comanagement. RESULTS Advanced practice clinician comanagement was associated with a 5% reduction in mean length of stay (rate ratio = 0.95, P = .009), decreased odds of returning to the operating room (odds ratio [OR] 0.51, P = .002), and a significant reduction in 30-day mortality (OR 0.32, P = .037) compared with usual orthopedic care in a weighted analysis. Need for ICU transfer was higher with advanced practice clinician comanagement (OR 1.54, P = .009), without significant differences in 30-day readmission or in-hospital mortality. CONCLUSIONS We observed reductions in length of stay, health care costs, return to the operating room, and 30-day mortality with advanced practice clinician comanagement compared with usual orthopedic care. Our findings suggest that advanced practice clinician-based comanagement may represent a safe and cost-effective model for orthopedic comanagement.
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Affiliation(s)
- Stacy A Johnson
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.
| | - Melissa Whipple
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - David R Kendrick
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Alexander Gouttsoul
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Kaleb Eppich
- Study Design and Biostatistics Center, Center for Clinical and Translational Science, University of Utah School of Medicine, Salt Lake City
| | - Chaorong Wu
- Study Design and Biostatistics Center, Center for Clinical and Translational Science, University of Utah School of Medicine, Salt Lake City
| | - Austin B Rupp
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Emily A Signor
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Santosh P Reddy
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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Olson CA, Eng-Kulawy J, Buckland-Coffey DD. Hospitalists as Facilitators of Surge and Contingency Medical Operations and Planning. Mil Med 2024; 189:70-73. [PMID: 37606620 DOI: 10.1093/milmed/usad320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/06/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
Hospital medicine, a specialty encompassing physicians and advanced practice providers in internal medicine, pediatrics, and family medicine, has been a core and rapidly growing component of civilian health care for the past two decades. More recently, hospitalists have been taking on key roles during surge and contingency planning and operations, most notably during the COVID-19 pandemic which necessitated marked changes in inpatient care across the United States. The military health system has been slower to incorporate hospitalists into clinical care and planning than civilian organizations due to its unique features. However, an increasing focus on future distributed operations in contested environments, pandemic care, and humanitarian assistance/disaster response requires new consideration of their role in military medicine. This stems from hospitalists' value as clinicians who include triage, resource utilization stewardship, medical inpatient care, pre-/post-operative management of surgical patients, and high acuity patient stabilization and management within their scope, often working collaboratively with other specialists such as emergency medicine physicians, surgeons, and intensivists. Just as importantly, hospitalists are system-level facilitators and leaders of patient capacity expansion and/or clinical process changes when needed for response to incidents in a variety of acute care scenarios. With uniformed billets being increasingly targeted to military platform requirements, there is now an opportunity to revisit the value of hospitalists in military medicine. In this Commentary, we review the roles that hospitalists can fill in hospital and operational medical settings, with a focus on surge and contingency operations. To demonstrate this capability, we present here the experience of two operational units employing hospitalists for high acuity patient management and two civilian hospitals implementing surge operations during the 2022-2023 "tripledemic" of viral respiratory infections in the United States. Their innovations facilitated the care of higher acuity and higher volume during times when medical care requirements were limited by traditional staffing models. We end by reviewing opportunities and challenges related to expanding hospitalist use within the military health system and describing efforts that are underway to address the challenges.
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Affiliation(s)
- Christina A Olson
- NR Expeditionary Strike Group 7, NRC St. Louis, 10810 Lambert International Boulevard, Bridgeton, MO 63044, USA
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA
- Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Jennifer Eng-Kulawy
- U.S. Navy Bureau of Medicine and Surgery, 7700 Arlington Boulevard, Falls Church, VA 22042, USA
- Alexander T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA
- Department of Pediatrics, F. Edward Hebert School of Medicine at Uniformed Services of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA
- Inova L. J. Murphy Children's Hospital, 3300 Gallows Rd, Falls Church, VA 22042, USA
| | - Debra D Buckland-Coffey
- U.S. Navy Bureau of Medicine and Surgery, 7700 Arlington Boulevard, Falls Church, VA 22042, USA
- Alexander T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA
- Marine Corps Headquarters, Health Services, 701 South Courthouse Road, Arlington, VA 22204, USA
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Rogers NG, Carrillo-Marquez M, Carlisle A, Sanders CD, Burge L. Friends Not Foes: Optimizing Collaboration with Subspecialists. Orthop Clin North Am 2023; 54:277-285. [PMID: 37271556 DOI: 10.1016/j.ocl.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pediatric orthopedic patients can be complex to manage. As orthopedists plan for possible surgical interventions, consultation with pediatric subspecialists will be necessary. This article discusses the considerations an orthopedist should make when deciding on the timing and the appropriateness of consultation-both preoperatively and perioperatively. Consultation before surgical intervention will especially be useful if the subspecialist will be collaborating in the management of the condition postoperatively (whether inpatient or outpatient). Clear and early consultation in both written and verbal format will facilitate quality and expedite the patient's care.
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Affiliation(s)
- Nathaniel G Rogers
- Division of Pediatric Hospital Medicine, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA.
| | - Maria Carrillo-Marquez
- Division of Infectious Diseases, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
| | - Annette Carlisle
- Division of Allergy & Immunology, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
| | - Catherine D Sanders
- Division of Pulmonology, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
| | - Lauren Burge
- Division of Child Abuse, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
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Koh ZJ, Yeow M, Srinivasan DK, Ng YK, Ponnamperuma GG, Chong CS. A randomized trial comparing cadaveric dissection and examination of prosections as applied surgical anatomy teaching pedagogies. ANATOMICAL SCIENCES EDUCATION 2023; 16:57-70. [PMID: 34968002 DOI: 10.1002/ase.2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
Anatomy is an important component in the vertical integration of basic science and clinical practice. Two common pedagogies are cadaveric dissection and examination of prosected specimens. Comparative studies mostly evaluate their immediate effectiveness. A randomized controlled trial design was employed to compare both the immediate and long-term effectiveness of dissection and prosection. Eighty third-year medical students undergoing their surgical rotation from the Yong Loo Lin School of Medicine were randomized into two groups: dissection and prosection. Each participated in a one-day hands-on course following a similar outline that demonstrated surgical anatomy in the context of its clinical relevance. A pre-course test was conducted to establish baseline knowledge. A post-course test was conducted immediately after and at a one-year interval to evaluate learner outcome and knowledge retention. A post-course survey was conducted to assess participant perception. Thirty-nine and thirty-eight participants for the dissection and prosection groups, respectively, were included for analysis. There was no significant difference between mean pre-course test scores between the dissection and prosection groups [12.6 (3.47) vs. 12.7 (3.16), P > 0.05]. Both the mean immediate [27.9 (4.30) vs. 24.9 (4.25), P < 0.05] and 1 year [23.9 (4.15) vs. 19.9 (4.05), P < 0.05] post-course test scores were significantly higher in the dissection group. However, when adjusted for course duration [dissection group took longer than prosection group (mean 411 vs. 265 min)], these findings were negated. There is no conclusive evidence of either pedagogy being superior in teaching surgical anatomy. Based on learner surveys, dissection provides a greater learner experience.
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Affiliation(s)
- Zong Jie Koh
- Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Marcus Yeow
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Dinesh Kumar Srinivasan
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yee Kong Ng
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gominda G Ponnamperuma
- Department of Medical Education, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Choon Seng Chong
- Division of Colorectal Surgery, Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
- Dean's office, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Hepner D, Harrop CM, Whinney C, Gulur P. Pro-Con Debate: Anesthesiologist- Versus Hospitalist- Run Preoperative Clinics and Perioperative Care. Anesth Analg 2022; 134:466-474. [PMID: 35180163 DOI: 10.1213/ane.0000000000005877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this Pro-Con commentary article, we discuss the models, value propositions, and opportunities of preoperative clinics run by anesthesiologists versus hospitalists and their role in perioperative care. The medical and anesthesia evaluation before surgery has pivoted from the model of "clearance" to the model of risk assessment, preparation, and optimization of medical and psychosocial risk factors. Assessment of these risk factors, optimization, and care coordination in the preoperative period has expanded the roles of anesthesiologists and hospitalists as members of the perioperative care team. There is ongoing debate regarding which model of preoperative assessment provides the most optimal preparation for the patient undergoing surgery. This article hopes to shed light on this debate with the data and perspectives on these care models.
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Affiliation(s)
- David Hepner
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Catriona M Harrop
- Department of Clinical Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Padma Gulur
- Department of Anesthesiology, Duke University, Durham, North Carolina
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Lyons M, McGregor PC, Pinzur MS, Adams W, Wilkos-Prostran L. Risk Reduction and Perioperative Complications in Patients With Diabetes and Multiple Medical Comorbidities Undergoing Charcot Foot Reconstruction. Foot Ankle Int 2021; 42:902-909. [PMID: 33629589 DOI: 10.1177/1071100721995422] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Modern patient safety programs focus on medical optimization of patients prior to surgery, regional anesthesia when possible, and hospitalist-orthopedic co-management during the perioperative period. METHODS Eighty-five consecutive patients with diabetes and multiple medical comorbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized risk reduction program that included medical optimization prior to surgery, regional anesthesia whenever possible, and hospitalist-orthopedic co-management during the perioperative period. Charts were retrospectively reviewed for medical comorbidities, complications, and length of stay. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Risk Calculator was used to retrospectively calculate their predicted perioperative risk. RESULTS On multivariable analysis, longer lengths of stay were associated with low preoperative hemoglobin values (rate ratio [RR], 1.36; P = .01) and congestive heart failure (RR, 1.42; P = .02). There were 22 (26%) complications, though only 10 (12%) were serious. These included acute kidney injury (n = 6), sepsis (n = 2), 1 cardiac event, and 1 pulmonary embolism. Overall, the accuracy of predicting a complication using the ACS NSQIP Risk Calculator was 74% (95% CI, 63%-85%), which was comparable to the accuracy of predicting a complication using only patients' congestive heart failure and pin-tract infection statuses (c = 74%, 95% CI, 62%-86%). DISCUSSION Medical optimization of patients with diabetes and multiple medical comorbidities prior to elective complex reconstruction orthopedic surgery allows the surgery to be performed with a predictable risk for perioperative complications. Preoperative anemia and congestive heart failure are associated with longer hospitalizations in this patient group. The ACS NSQIP Risk Calculator appears to be a reliable predictor of complications during the perioperative period. This study demonstrates that reconstructive surgery in this complex patient population can be accomplished with a reasonable exposure to perioperative risk. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Madeline Lyons
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - Patrick Cole McGregor
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - Michael S Pinzur
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA
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Jung YB, Jung EJ, Lee KY. A surgical hospitalist system in Korea: a preliminary study of the effects on hospital costs and postoperative outcomes. Ann Surg Treat Res 2021; 100:298-304. [PMID: 34012948 PMCID: PMC8103155 DOI: 10.4174/astr.2021.100.5.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/09/2020] [Accepted: 01/23/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose The aim of this study is to investigate the effect of the surgical hospitalist system on postoperative outcomes and hospital costs for surgical patients. Methods We reviewed the medical records of 522 patients who were admitted to the divisions of colorectal and gastrointestinal surgery for operation from September to December 2017 at Severance Hospital, Yonsei University College of Medicine in Seoul, Korea. All patients were divided into 2 groups; one that was managed by surgical hospitalists group (HG) and another that was managed by non-hospitalist residents group (NHG) after elective surgery. Postoperative outcomes and hospital costs were analyzed for each group. Results Two hundred ninety-eight patients were managed by HG and 189 patients were managed by NHG after surgery. The length of hospital stay in the first group was shorter (9.6 ± 5.8 days vs. 12.2 ± 7.9 days, P < 0.001), the incidence of complications was lower (44.6% vs. 55.6%, P = 0.019), and the readmission rate was lower (3.0% vs. 6.9%, P = 0.046) in the HG than in the NHG. The difference in total hospital costs was not significant between the HG and the NHG (₩8,381,304 vs. ₩9,242,493, P = 0.559), but surgery-independent hospital costs were lower in the HG than in the NHG (₩3,020,873 vs. ₩3,923,308, P = 0.001). Conclusion The surgical hospitalist system reduced the length of hospital stay, the incidence of postoperative complications, and the readmission rates of surgical patients. This led to the effect of a reduction in total hospital costs.
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Affiliation(s)
- Yoon Bin Jung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Joo Jung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Young Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00003. [PMID: 33720101 PMCID: PMC7954368 DOI: 10.5435/jaaosglobal-d-20-00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/30/2021] [Indexed: 11/21/2022]
Abstract
Rotating medical consultants, hospitalists or geriatricians, are involved in the care of patients with hip fracture, often after medical complications have already occurred. In August 2012, we implemented a unique surgical comanagement (SCM) model in which the same Internal Medicine hospitalists are dedicated year-round to the orthopaedic surgery service. We examine whether this SCM model was associated with a decrease in medical complications, length of stay, and inpatient mortality in patients with hip fracture admitted at our institution, compared with the previous model.
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Strizich L, Kim CS. Improving Outcomes for Medically Complex Patients Undergoing Hip Fracture Surgery: It Will Take a Village. Jt Comm J Qual Patient Saf 2021; 47:205-206. [PMID: 33678526 DOI: 10.1016/j.jcjq.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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