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The Value of the Pediatric Hospitalist in Surgical Co-Management

  • Hospital Medicine (A Statile and N Unaka, Section Editors)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Abstract

Purpose of review

This review summarizes the most recent evidence regarding the impact of hospitalist co-management of surgical patients, with a particular emphasis on value. Value is defined as quality (clinical outcomes) divided by cost.

Recent findings

As the engagement of hospitalists in surgical co-management originated in adult hospital medicine, we will review the adult and pediatric literature. We will also examine the inclusion of pediatric hospitalists as key members of improvement teams focused on improving outcomes and value for surgical patients; while such teams often evolve out of co-management partnerships, they may demonstrate impact beyond the daily care model and thus have an outsized impact on value.

Summary

We conclude by commenting on the selective application of the co-management model, based on the literature, to optimize value.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. de Brantes F, Rosenthal MB, Painter M. Building a bridge from fragmentation to accountability—the Prometheus Payment model. N Engl J Med. 2009;361(11):1033–6.

    Article  PubMed  Google Scholar 

  2. CMS. Centers for Medicare and Medicaid bundled payments for care improvement website. 2016;2016(04/25/2016). https://innovation.cms.gov/initiatives/bundled-payments/.

  3. Sharma G, Kuo Y-F, Freeman J, Zhang DD, Goodwin JS. Comanagement of hospitalized surgical patients by medicine physicians in the United States. Arch Intern Med. 2010;170(4):363–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. SHM. Society of Hospital Medicine. Resources for effective co-management of hospitalized patients. https://www.hospitalmedicine.org/practice-management/co-management. Retrieved March 7, 2018. https://www.hospitalmedicine.org/practice-management/co-management.

  5. Vora H, Atchley B, Behnke S, Cockerham C, Pyke O, Sittig R. The evolution of co-management in hospital medicine. https://www.hospitalmedicine.org/globalassets/practice-management/practice-management-pdf/pm-17-0019-co-management-white-paper-m1.pdf.

  6. Rosenburg R, Abzug J, Rappaport D, et al. Collaborations with pediatric hospitalists: national surveys of pediatric surgeons and orthopedic surgeons. J Hosp Med 2018.

  7. • Tadros RO, Tardiff ML, Faries PL, et al. Vascular surgeon-hospitalist comanagement improves in-hospital mortality at the expense of increased in-hospital cost. J Vasc Surger. 2017;65(3):819–25. This work examines the cost associated with a remarkable mortality benefit in including hospitalists in a co-management model for vascular surgery adult patients.

    Article  Google Scholar 

  8. Tadros RO, Faries PL, Malik R, Vouyouka AG, Ting W, Dunn A, et al. The effect of a hospitalist comanagement service on vascular surgery inpatients. J Vasc Surg. 2015;61(6):1550–5.

  9. • Bracey DN, Kiymaz TC, Holst DC, et al. An orthopedic-hospitalist comanaged hip fracture service reduces inpatient length of stay. Geriatr Orthop Surger Rehabil. 2016;7(4):171–7. A co-management model for geriatric adults following hip fracture was associated with increased length of stay.

    Article  Google Scholar 

  10. Rohatgi N, Loftus P, Grujic O, Cullen M, Hopkins J, Ahuja N. Surgical comanagement by hospitalists improves patient outcomes. Ann Surg. 2016;264(2):275–82.

    Article  PubMed  Google Scholar 

  11. Huddleston J, Long KH, Naessens J, et al. Hospitalist-orthopedic team trial investigators medical and surgical comanagement after elective hip and knee arthroplasty: a randomized, controlled trial. Ann Intern Med. 2004;141(1):28–38.

    Article  PubMed  Google Scholar 

  12. Auerbach AD, Wachter RM, Cheng HQ, Maselli J, McDermott M, Vittinghoff E, et al. Comanagement of surgical patients between neurosurgeons and hospitalists. Arch Intern Med. 2010;170(22):2004–10.

  13. Simon TD, Eilert R, Dickinson LM, Kempe A, Benefield E, Berman S. Pediatric hospitalist comanagement of spinal fusion surgery patients. J Hosp Med. 2007;2(1):23–30. http://www.ncbi.nlm.nih.gov/pubmed/17274045

    Article  PubMed  Google Scholar 

  14. •• Rappaport DI, Adelizzi-Delany J, Rogers KJ, et al. Outcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery. Hospital Pediatr. 2013;3(3):233–41. This work examines the outcomes and costs of a pediatric hospitalist co-management model for medically complex children undergoing spinal fusion.

    Article  Google Scholar 

  15. •• Simon TD. How best to design surgical comanagement services for pediatric surgical patients? Hospital Pediatr. 2013;3(3):242. Simon compares and contrasts two studies of co-management for medically complex children undergoing spinal fusion study, and comments on features most likely to be associated with the highest healthcare value.

    Article  Google Scholar 

  16. •• Shaughnessy EE, White C, Shah SS, Hubbell B, Sucharew H, Sawnani H. Implementation of postoperative respiratory care for pediatric orthopedic patients. Pediatrics. 2015;136(2):e505–12. http://www.ncbi.nlm.nih.gov/pubmed/26195544. A multidisciplinary group implements a unique intervention to improve respiratory outcomes for medically complex children after hip and spine surgery.

  17. Meier K, Benz L, Greger S, et al. Implementation of a standardized approach to pediatric postoperative urinary retention decreases rate of intervention. BMJ J 2016;25(12).

  18. •• Brower LH, Kremer N, Meier K, Wolski C, McCaughey MM, McKenna E, et al. Quality initiative to introduce pediatric venous thromboembolism risk assessment for orthopedic and surgery patients. Hospital Pediatr. 2017;7(10):595–601. This study compares and contrasts different implementation approaches for VTE risk assessment in two different pediatric surgical patient populations.

  19. Meier KA, Clark E, Tarango C, Chima RS, Shaughnessy E. Venous thromboembolism in hospitalized adolescents: an approach to risk assessment and prophylaxis. Hospital Pediatr. 2015;5(1):44–51.

    Article  Google Scholar 

  20. Schaffzin JK, Prichard H, Bisig J, et al. A collaborative system to improve compartment syndrome recognition. Pediatrics. 2013;132(6):e1672–9.

    Article  PubMed  Google Scholar 

  21. Schaffzin JK, Harte L, Marquette S, et al. Surgical site infection reduction by the solutions for patient safety hospital engagement network. Pediatrics. 2015;136(5):e1353–60. http://pediatrics.aappublications.org/content/136/5/e1353

    Article  PubMed  Google Scholar 

  22. McLeod L, Flynn J, Erickson M, Miller N, Keren R, Dormans J. Variation in 60-day readmission for surgical-site infections (SSIs) and reoperation following spinal fusion operations for neuromuscular scoliosis. J Pediatr Orthop. 2016;36(6):634–9.

    Article  PubMed  Google Scholar 

  23. Rosenberg RE, Trzcinski S, Cohen M, Erickson M, Errico T, McLeod L. The association between adjuvant pain medication use and outcomes following pediatric spinal fusion. Spine. 2017;42(10):E602–8.

    Article  PubMed  Google Scholar 

  24. Shaughnessy EE, Kirkland LL. Malnutrition in hospitalized children: a responsibility and opportunity for pediatric hospitalists. Hospital Pediatr. 2016;6(1):37–41.

    Article  Google Scholar 

  25. Goldstein SL, Mottes T, Simpson K, Barclay C, Muething S, Haslam DB, et al. A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury. Kidney Int. 2016;90(1):212–21.

  26. • Shaughnessy EE, Sturm P, Sitzman TJ. Feasibility of episode-based bundled payment for a pediatric surgical condition: posterior spinal fusion. Pediatr Quali Safety. 2017;2(4):e028. This perspectives’ piece proposes posterior spinal fusion in adolescents with idiopathic scoliosis as an attractive target for an alternative payment model.

    Google Scholar 

  27. • Rappaport DI, Rosenberg RE, Shaughnessy EE, et al. Pediatric hospitalist comanagement of surgical patients: structural, quality, and financial considerations. J Hosp Med. 2014;9(11):737–42. http://www.ncbi.nlm.nih.gov/pubmed/25283766. This paper reviews considerations for programs considering implementing a hospitalist co-management program for pediatric surgical patients.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank Melissa Gray for technical assistance with the manuscript.

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Correspondence to Erin E. Shaughnessy MD, MSHCM.

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Conflict of Interest

Erin E. Shaughnessy declares that he has no conflict of interest. Katie A. Meier declares that she has no conflict of interest. Kelly Kelleher declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Hospital Medicine

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Shaughnessy, E.E., Meier, K.A. & Kelleher, K. The Value of the Pediatric Hospitalist in Surgical Co-Management. Curr Treat Options Peds 4, 247–254 (2018). https://doi.org/10.1007/s40746-018-0125-0

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