Hospitalist Co-Management Improves Outcomes and Decreases Costs for an Inpatient Vascular Surgery Service

Abstract

Vascular surgery patients often have multiple comorbidities with increased length of stay and readmission rates, thus leading to higher health care-related costs. Hospitalists can be instrumental in optimal management of chronic comorbidities and in timely recognition and management of acute medical issues. Our aim was to evaluate the outcomes and cost of a hospitalist co-management team for an inpatient vascular surgery service. We instituted co-management for vascular surgery inpatients from April 2019 to October 2019 with one hospitalist and five vascular surgeons. The hospitalist worked closely with the vascular surgery attendings and with the support staff, including house staff, physician assistants, consultants, social workers, and case managers. The hospitalist conducted rounds with the vascular team daily to discuss medical plans for the day and led interdisciplinary rounds with all disciplines involved in the care of the patient. We compared an 8-month period before initiation of co-management (July 2018-March 2019) with a 6-month period after initiation (April 2019-October 2019). We assessed outcomes in terms of length of stay, length of intensive care unit days, readmission, and mortality. We also performed a financial analysis of the direct variable care cost. The period before co-management included a total of 542 patients; after co-management, there were 285 patients. The case mix index was 2.40 at baseline and 2.44 after co-management, suggesting similar patient complexity. After institution of hospital co-management, there was a significant decrease in length of stay by 1.18 days (Table; P < .05), which opened 2.2 telemetry beds per day. Furthermore, there was a significant decrease in average intensive care unit days per 100 patients from 57% to 37% (P < .05). This was primarily due to reduced escalations in level of care. Excess days per patient improved from −0.59 to −1.65. Along with the decreased length of stay, we had a 7% reduction in our readmission index (Table). The mortality index decreased from 0.83 to 0.63. In terms of direct variable care cost, the ancillary and room and board costs per patient decreased by $577 and $1159, respectively, leading to a decrease in overall direct variable cost of $1736 per patient. As a result, there was an overall cost savings of $494,760 during the study period and an annualized cost savings of $1,329,776. Hospitalist co-management improves outcomes for vascular surgery inpatients and decreases length of stay, readmission, and mortality while providing a significant cost savings.TableComparison of quality outcomes with and without hospitalist Comanagement (a denotes statistical significance P < .05)OutcomePre-comanagementPost-comanagementLength of staya5.14 days3.96 daysReadmission index (observed/expected)1.541.45Mortality index (observed/expected).83.63Average cost (per patient)a$6501$5098 Open table in a new tab