BackgroundPerioperative care has been identified as an area of wide variability in quality, with conflicting models, and involving multiple specialties. In 2014, the Loma Linda University Departments of Anesthesiology and Urology implemented a perioperative hospitalist service (PHS), consisting of anesthesiology-trained physicians, to co-manage patients for the entirety of their perioperative period. We hypothesized that implementation of this PHS model would result in an improvement in patient recovery.MethodsAs a quality improvement (QI) initiative, the PHS service was formed of selected anesthesiologists who received training on the core competencies for hospitalist medicine. The service was implemented following a co-management agreement to medically manage patients undergoing major urologic procedures (prostatectomy, cystectomy, and nephrectomy). Impact was assessed by comparisons to data from the year prior to PHS service implementation. Data was compared with and without propensity matching. Primary outcome marker was a reduction in length of stay. Secondary outcome markers included complication rate, return of bowel function, number of consultations, reduction in total direct patient costs, and bed days saved.ResultsSignificant reductions in length of stay (p < 0.05) were demonstrated for all surgical procedures with propensity matching and were demonstrated for cystectomy and nephrectomy cases without. Significant reductions in complication rates and ileus were also observed for all surgical procedures post-PHS implementation. Additionally, reductions in total direct patient costs and frequency of consultations were also observed.ConclusionsAnesthesiologists can safely function as perioperative hospitalists, providing appropriate medical management, and significantly improving both patient recovery and throughput.Electronic supplementary materialThe online version of this article (10.1186/s13741-018-0090-y) contains supplementary material, which is available to authorized users.
A technique has been described that is effective in the evaluation of microcirculation in experimental bone grafts. This method employs India ink with a perfusion pump. These materials provide an inexpensive, rapid, and simple protocol that yields consistent, repeatable results with graphic demonstration of microcirculation in experimental bone grafts.
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