Mayo Clinic Proceedings provided another addition to the growing literature on hospitalist care with this study of hip fracture surgery, comparing hospitalists with traditional primary care physicians for medical consultation. Hospitalist consultation was associated with statistically significant reductions in time to consultation and time to surgery. Cost and length of stay reductions were not statistically significant. Previous literature has suggested that reduced time to surgery is associated with better outcomes.
The discussion section describes practice patterns of hospitalists at the study site (Mayo Clinic Jacksonville) and speculates how hospitalists might improve outcomes for surgical patients.
3 comments:
This is a no-brainer. If I get a call for a pre-op consultation and clearance for a hip fracture patient, I cannot drop everything, cancel my office hours, and rush to the hospital to do the consultation. I go to the hospital in the evening after office hours, and the surgery is done the next day. With the hospitalist, the consultation can be done in the ER, and an orthopedist can do the surgery as an "add-on" procedure the same day. The patient gets the operation and is rushed off to a nursing home for "rehab." I would like to see a study using valid outcome such as percentage that become ambulatory again or percentage that return home. A one day difference in length of stay is only relevant to the hospital CFO.
I tend to agree, any care that is rendered faster can improve outcomes ...especially if the outcomes valued refelct short term goals instead of long term effects....ie aunt betsy is doing well two months post ORIF 9 not just 4 days post op)
the physicians who are becoming are hospitalists are either former primary care office based docs or doc's who are trained to to general/primary care internal medicine but decide never to leave thwe hospital after training.
Thus, as the number of primary care docs decline
(they are) and the number of hospitalists rise...I am sure one can do a study showing better short term outcomes in the hospital but worse outcomes in the outpatient world.
The fragmentation of care is incredible. The hip fracture patient gets rushed in and out of the hospital orchestrated by the inpatient hospitalist. Most are too old or have too many co-morbidities for inpatient rehab, so they get pushed into nursing homes (aka "nursing and rehab center"). The primary care doctor no longer goes to the nursing homes because of reimbursement and liability issues, so the patient is now managed by the nursing home doctor. After using up all of the available Medicare skilled nursing benefits, the patient is then sent home and by then may or may not be able to get around enough to see their original PCP. If not, care is orchestrated by telephone with a home care agency until the patient deteriorates enough or has another crisis that sends them back to the hospital. This scenario goes on time after time, and I don't see how anyone who works in the field can state that outcomes are better than in the days when the primary care physician remained involved in all aspects of the care. The study will never be done, because there are no longer very many PCP's who can do this.
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