An internist joins the surgery service: does comanagement make a difference?
OBJECTIVE
To determine the effect of internist comanagement of cardiothoracic surgical patients on patient outcome and resource utilization.


METHODS
Before/after comparison.


METHODS
Tertiary care university-affiliated Veterans Affairs hospital.


METHODS
165 patients (86 before the intervention and 79 after the intervention) undergoing cardiothoracic surgery.


METHODS
All patients were seen preoperatively and at least daily through discharge by a comanaging staff internist who was a full-time member of the surgical team.


METHODS
Length of stay, in-hospital mortality, and laboratory and radiology utilization.


RESULTS
Significant shortening of postoperative length of stay (18.1 days before and 12.1 days after, p = 0.05) and total length of stay (27.2 days before and 19.7 days after, p = 0.03) was noted. The in-hospital mortality rate for the patients undergoing surgery was 8.1% before the intervention versus 2.5% afterward (p = 0.17). There were significant reductions in the total number of x-rays (p = 0.02) and nearly significant reductions in total laboratory test utilization (p = 0.06). Referring physicians and surgeons both believed that the contribution of the internist was important.


CONCLUSIONS
The addition of an internist to the cardiothoracic surgery service at a tertiary care teaching center was associated with decreased resource utilization and possible improved outcomes. Before becoming more widely adopted, this intervention deserves further exploration at other sites using stronger study designs.
Department of Medicine, University of Pittsburgh, Pennsylvania.
D S
DS
Macpherson
C
C
Parenti
J
J
Nee
R A
RA
Petzel
H
H
Ward
D017052:Hospital Mortality; D006787:Hospitals, Veterans; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D012017:Referral and Consultation; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D013903:Thoracic Surgery / Q000458:organization & administration*