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.
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