Archivos de la Sociedad Española de Oftalmología (English Edition)
Original articleEffect of co-management with Internal Medicine on hospital stay in OphthalmologyEfecto de la asistencia compartida (comanagement) con Medicina Interna sobre la estancia hospitalaria de los pacientes ingresados en el servicio de Oftalmología☆
Introduction
Improvements in anesthetic and surgical techniques and procedures are enabling surgery services to increase operations on older patients and those exhibiting comorbidity.1 On the other hand, the development of outpatient and short-stay surgery enables many patients to return home a few hours after an operation or to remain in hospital for very brief periods. As a result, patients remaining in hospital after surgery are of increasing age, comorbidity and complexity, making the surgeons work more difficult. This difficulty gives rise to greater cooperation between medical departments to attend surgery patients with the ensuing increase of inter-department consultations with Internal Medicine1 (IM), which is not the most efficient method.2
Even though there is very little information on this issue, the Ophthalmology Dept. (OPH) is also involved in the situation as it is a specialty which performs most of its surgical interventions on an outpatient basis, in addition on patients with very low overall morbidity and mortality considered to be of low risk.3, 4 Accordingly, our specialty has very little weight in hospitalization (low number of admissions and intra-department consultations) and virtually no information about patients admitted in OPH. However, the low number of ophthalmological patients who remain in hospital is definitely not within the low risk group, as they are admitted due to their disease and comorbidity as well as to complications. In fact, their mean age and comorbidity is higher than that of the majority of hospital departments5 and over 70% exhibited significant medical comorbidity.6
An alternative to inter-department consultations is comanagement (CM) with IM, a practice that is gradually extending, particularly in large hospitals, and has demonstrated a significant efficiency in our environment.7 In May 2011, comanagement was initiated with the OPH department, which is very different to other surgical services due to its characteristics and type of patients. We have not found in the literature any type of cooperation between IM and OPH comparable to that described in this article.
The objective is to analyze the effect of CM with IM on the hospital stay of patients admitted in OPH.
Section snippets
Material and method
At present, our hospital has 450 beds and covers an almost exclusively urban population of 250,000 inhabitants. It includes pre-and post-graduate teaching and is accredited for training medical and surgical residents. The study included all patients ≥14 years of age released from January 1, 2009 up to June 30, 2013 from the OPH service. During this period the activity of this department did not undergo significant organizational changes with the sole exception of CM with IM, which was initiated
Statistical analysis
Age, stay, administrative weight, number of diagnostics and ICh are described against median values and 95% confidence interval (CI 95%). The rest of variables, all qualitative, are described in percentages and 95% CI. Considering the type of work and the clinical nature of results, a precision of ±5 centesimal points was considered sufficient, and therefore the numbers were rounded to one decimal point, with the exception of the administrative weight in which the 4 decimals were maintained.
Results
During the study period, OPH released 589 patients ≥14 years. The CM group exhibited 15.9% of significant variations in the number of patients submitted to surgery, 12% in administrative weight and 47.4% in the number of diagnostics (Table 1). The mean adjusted stay was of −0.5 days (CI 95% −1 to −0.1; p = 0.039), a reduction of 27.8%. No demise occurred during the period of the study.
Utilizing as reference the cost of stay in IM, the least expensive one, CM achieved a mean reduction of stay
Discussion
The relevance of analyzing hospital stays lies in that, among other reasons, is a good indicator of adverse events10 and cost of attention.11 Our results show that comorbidity and complexity of patients admitted in OPH is on the increase, and that CM with IM is associated to a reduction in hospital stays and associated economic costs. Even though the economic repercussions of CM do not seem to be very big, the workload for the IM service is not very large either as its involves visiting a mean
Conflict of interests
No conflict of interests has been declared by the authors.
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Cited by (0)
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Please cite this article as: Montero Ruiz E, Rebollar Merino A, Castejón Cervero MA, Barbero Allende JM, Culebras López, García Sánchez M. Efecto de la asistencia compartida (comanagement) con Medicina Interna sobre la estancia hospitalaria de los pacientes ingresados en el servicio de Oftalmología. Arch Soc Esp Oftalmol. 2015;90:253–256.