Hospitalist Comanagement of Neurosurgery Patients

1Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
2Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
3Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
4Jefferson Hospital for Neurosciences and Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 123

Background:

When the 80‐hour restriction took effect nationwide, surgical trainees' time outside the operating room became inadequate to optimally manage complex patients in the perioperative period. A busy neuroscience facility specializing in treatment of arteriovenous malformations, brain tumors and intracranial hemorrhages was interested in improving the quality of care provided to its patients. A neurointensivist already followed all the patients in the ICU. The hospitalist service was asked to assist with medical management on the other units, thereby allowing the surgical house staff to focus primarily on neurosurgical issues.

Purpose:

To describe the implementation of a hospitalist‐neurosurgery comanagement model for the care of patients treated at a neuroscience hospital.

Description:

The hospitalist group is responsible for the 35 beds outside the ICU. Two hospitalists are assigned to this service on a daily basis. Working closely with the neurosurgical nurse‐practitioners and residents, our duties include preoperative evaluations, management of chronic medical conditions, and nonneurological issues that arise postoperatively in this distinct patient population. If a subspecialist consultation is still required, the hospitalist can act as a liaison between the consulting service and the neurosurgical staff. We are also available to assist with coordination of outpatient follow‐up at the time of discharge.

Conclusions:

The hospitalist‐neurosurgery model represents a relatively unique comanagement system that has already shown favorable effects. Traditionally, cancellations were common, as outpatient physicians were often unaware of the specific requirements for the planned procedures. Because hospitalists have assumed the responsibility of preoperative evaluations, there are fewer disruptions in care, improving both patient and surgeon satisfaction. The availability of a hospitalist on the unit has helped nursing care and nurse‐practitioner efficiency and communication of consultant recommendations. Since the program was fully instituted over the past year, the average length of stay has decreased from 5.32 days in 2006 to 4.30 days in 2007. Currently this is a mandatory 1‐month rotation for first year neurosurgical residents. In the future, there are plans to incorporate this into an elective rotation for Internal Medicine residents who are interested in hospitalist careers.

Author Disclosure:

E. Teperov, none; J. Fink, none; G. Merli, none; R. Rosenwasser, none.

To cite this abstract:

Teperov E, Fink J, Merli G, Rosenwasser R. Hospitalist Comanagement of Neurosurgery Patients. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 123. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/hospitalist-comanagement-of-neurosurgery-patients/. Accessed September 22, 2019.

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