Effect of Active Surgical Co-Management by Medical Hospitalists in Urology Inpatient Care: A Retrospective Cohort Study

다국어 초록 (Multilingual Abstract)

Purpose: This study aimed to evaluate the use of active surgical co-management (SCM) by medical hospitalists for urology inpa tient care.
Materials and Methods: Since March 2019, a hospitalist-SCM program was implemented at a tertiary-care medical center, and a retrospective cohort study was conducted among co-managed urology inpatients. We assessed the clinical outcomes of urology inpatients who received SCM and compared passive SCM (co-management of patients by hospitalists only on request; March 2019 to June 2020) with active SCM (co-management of patients based on active screening by hospitalists; July 2020 to October 2021). We also evaluated the perceptions of patients who received SCM toward inpatient care quality, safety, and subjective satis faction with inpatient care at discharge or when transferred to other wards.
Results: We assessed 525 patients. Compared with the passive SCM group (n=205), patients in the active SCM group (n=320) re quired co-management for a significantly shorter duration (p=0.012) and tended to have a shorter length of stay at the urology ward (p=0.062) and less frequent unplanned readmissions within 30 days of discharge (p=0.095) while triggering significantly fewer events of rapid response team activation (p=0.002). No differences were found in the proportion of patients transferred to the intensive care unit, in-hospital mortality rates, or inpatient care questionnaire scores.
Conclusion: Active surveillance and co-management of urology inpatients by medical hospitalists can improve the quality and efficacy of inpatient care without compromising subjective inpatient satisfaction.

참고문헌 (Reference)

1 장성인, "한국형 입원전담전문의 제도의 도입과 시범사업 평가를 통한 발전방향" 대한의사협회 62 (62): 558-563, 2019

2 United Nations Department of Economic and Social Affairs, "World population ageing 2020 highlights: living arrangements of older persons"

3 Klein LE, "The preoperative consultation. Response to internists’ recommendations" 143 : 743-744, 1983

4 Beresford L, "The comanagement conundrum" The Hospitalist: Society of Hospital Medicine 2011

5 Goldman L, "Ten commandments for effective consultations" 143 : 1753-1755, 1983

6 Rohatgi N, "Surgical comanagement by hospitalists improves patient outcomes : a propensity score analysis" 264 : 275-282, 2016

7 Tanriover MD, "Should every adult patient in the hospital have an internist?" 131 : 283-284, 2013

8 Salerno SM, "Principles of effective consultation : an update for the 21st-century consultant" 167 : 271-275, 2007

9 Detsky AS, "Predicting cardiac complications in patients undergoing non-cardiac surgery" 1 : 211-219, 1986

10 Boddaert J, "Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture" 9 : e83795-, 2014

11 Simon TD, "Pediatric hospitalist comanagement of spinal fusion surgery patients" 2 : 23-30, 2007

12 Kammerlander C, "Ortho-geriatric service--a literature review comparing different models" 21 (21): S637-S646, 2010

13 Kim SW, "Multidimensional frailty score for the prediction of postoperative mortality risk" 149 : 633-640, 2014

14 Pearse RM, "Mortality after surgery in Europe : a 7 day cohort study" 380 : 1059-1065, 2012

15 Siegal EM, "Just because you can, doesn’t mean that you should : a call for the rational application of hospitalist comanagement" 3 : 398-402, 2008

16 Eagle KA, "Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery" 93 : 1278-1317, 1996

17 American College of Physicians, "Guidelines for assessing and managing the perioperative risk from coronary artery disease associated with major noncardiac surgery" 127 : 309-312, 1997

18 Letica-Kriegel AS, "Feasibility of a geriatric comanagement(GERICO)pilot program for patients 75 and older undergoing radical cystectomy" 48 : 1427-1432, 2022

19 Shaw M, "Evaluation of internal medicine physician or multidisciplinary team comanagement of surgical patients and clinical outcomes : a systematic review and metaanalysis" 3 : e204088-, 2020

20 Montero Ruiz E, "Effect of comanagement with internal medicine on hospital stay of patients admitted to the service of otolaryngology" 66 : 264-268, 2015

21 Chae W, "Development and evolution of hospital medicine in Korea" 16 : 247-250, 2021

22 Della Rocca GJ, "Comanagement of geriatric patients with hip fractures : a retrospective, controlled, cohort study" 4 : 10-15, 2013

23 Detsky AS, "Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index" 146 : 2131-2134, 1986

24 Stier G, "Anesthesiologists as perioperative hospitalists and outcomes in patients undergoing major urologic surgery: a historical prospective, comparative effectiveness study" 7 : 13-, 2018

25 정윤빈 ; Eun-Joo Jung ; 이강영, "A surgical hospitalist system in Korea: a preliminary study of the effects on hospital costs and postoperative outcomes" 대한외과학회 100 (100): 298-304, 2021