SS09. Sustained Improvements in Inpatient Outcomes Following Implementation of Vascular Surgeon-Hospitalist Comanagement Service

  • Tadros R
  • Png C
  • Tardiff M
  • et al.
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Abstract

Objectives: We previously demonstrated early improvements in inpatient outcomes after starting a vascular surgeon-hospitalist comanagement service (HCS). This study aims to investigate the long-term impact of the program. Methods: A total of 2428 consecutive patients were reviewed: 946 patients who were managed before the comanagement system was implemented (January 2011 to December 2012) and 1482 who were comanaged (January 2013 to December 2014). The in-hospital mortality rates (IHM), length of stay (LOS), 30-day readmission rates (RAR), and 0-10 visual analog pain scores (VAP) were calculated and compared. In addition, patient adult safety assessments using the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators, and responses to a 10-question nursing survey were analyzed. Results: After the implementation of the HCS, the IHM rate decreased from 2.01% to 0.96% (P <.05). There was also a decrease in the observed-to-expected ratio from 1.22 to 0.52, accompanied by a drop in the risk-adjusted IHM from 2.44% to 0.48% (P <.001). The 30-day RAR remained similar, 20.4% in the comanaged group compared to 21.9% (P =.36). Correspondingly, the related 30-day RAR was similarly unchanged, 11.5% in the comanaged cohort compared to 12.1% (P =.19). There was a significant increase in LOS after the start of the HCS, 6.17 days compared to 5.35 days before comanagement (P <.01). Importantly, the case-mix index (CMI) also increased during the study period, 2.26 before comanagement compared to 2.51 after (P <.001). When LOS is adjusted for the increased CMI, the difference between groups is no longer significant (5.68 days vs 5.95 days; P =.281). The increased CMI alone resulted in longer LOS (P <.001). VAP scores showed significant improvements in rates of mild and moderate pain (P <.05). AHRQ data showed improvements or no change in all 15 reported safety indicator categories. Nursing surveys showed significant improvements in understanding patient care, communication with surgeons, and overall patient well-being (P <.05). Conclusions: The implementation of a vascular comanagement service resulted in significantly improved IHM rates despite increased CMI. Though increased LOS was observed, this finding is a reflection of increased CMI. In addition to improved IHM, pain, AHRQ safety measures, and nursing perceptions all improved.

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APA

Tadros, R. O., Png, C. Y. M., Tardiff, M., Assael, D., Kim, S. Y., Kang, M., … Faries, P. L. (2016). SS09. Sustained Improvements in Inpatient Outcomes Following Implementation of Vascular Surgeon-Hospitalist Comanagement Service. Journal of Vascular Surgery, 63(6), 52S-53S. https://doi.org/10.1016/j.jvs.2016.03.025

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