QS171. Impact of the Addition of Medical Hospitalist Service to Acute Care Surgical Service Workload

Abstract

Introduction: There is a perfect storm occurring in Hospital Medicine. Primary Care physicians are increasingly sending their patients to the hospital to be managed by full-time medical hospitalists. This trend has direct impact on acute care surgical service workload. We reviewed our in-house consult experience following the institution of a medical hospitalist service. Methods: Two consecutive time periods totaling 36 months, 1/04 - 6/05 (Time Period A) and 7/05 - 1/07 (Time Period B) were reviewed for in-house surgical consultations to the acute care surgical service. Number of consults, acuity (case mix index), time to request (TTR), diagnosis (Dx), and types of insurance were compared. The full-time medical hospitalist program was instituted in May 2005. Results: There were 637 consults in Time Period A which increased to 893 consults in Time Period B (28.7% increase). The Acuity as measured by case mix index decreased from 1.12 to 1.08 (3.6%) over these time periods. The Time To Request dropped by 60% from 15 hours to 6 hours from Admission. The number of different diagnoses increased from 18 to 23 (27.7%) and the percentage of self-pay (uninsured) consults decreased by 33%, from 12% to 8%, during the 36-month study period. Conclusion: As primary care physicians abdicate the in-hospital care of their patients to full-time medical hospitalists the workload for acute care surgeons significantly increases. These patients are seen sooner in the hospital, may be less ill with a wider range of diagnoses and more likely to possess health insurance. In our experience, the capability to perform endoscopy and laparoscopy greatly enhances the utilization of the acute care surgeon for in-house consultation. Tabled 1 Time Period A Time Period B % Change Number of Consults 637 893 28.7% Acuity 1.12 1.08 3.6% TTR (hours) 15 6 60% Diagnoses 18 23 27.7% Self-Pay Insurance (%) 12 8 33% Open table in a new tab