A surgical hospitalist system in Korea: a preliminary study of the effects on hospital costs and postoperative outcomes

Abstract

Purpose The aim of this study is to investigate the effect of the surgical hospitalist system on postoperative outcomes and hospital costs for surgical patients. Methods We reviewed the medical records of 522 patients who were admitted to the divisions of colorectal and gastrointestinal surgery for operation from September to December 2017 at Severance Hospital, Yonsei University College of Medicine in Seoul, Korea. All patients were divided into 2 groups; one that was managed by surgical hospitalists group (HG) and another that was managed by non-hospitalist residents group (NHG) after elective surgery. Postoperative outcomes and hospital costs were analyzed for each group. Results Two hundred ninety-eight patients were managed by HG and 189 patients were managed by NHG after surgery. The length of hospital stay in the first group was shorter (9.6 ± 5.8 days vs. 12.2 ± 7.9 days, P < 0.001), the incidence of complications was lower (44.6% vs. 55.6%, P = 0.019), and the readmission rate was lower (3.0% vs. 6.9%, P = 0.046) in the HG than in the NHG. The difference in total hospital costs was not significant between the HG and the NHG (₩8,381,304 vs. ₩9,242,493, P = 0.559), but surgery-independent hospital costs were lower in the HG than in the NHG (₩3,020,873 vs. ₩3,923,308, P = 0.001). Conclusion The surgical hospitalist system reduced the length of hospital stay, the incidence of postoperative complications, and the readmission rates of surgical patients. This led to the effect of a reduction in total hospital costs.

Changes in failure to rescue after gastrectomy at a large-volume center with a 16-year experience in Korea

“…Over the past few years, efforts have been made to improve the outcomes of hospitalized patients, including the onboarding of a surgical hospitalist, surgical ICU staff, and a rapid response team. The surgical hospitalist system, including a hospitalist with a surgical board, was established in 2016, representing the most significant change in perioperative care 35 – 37 . Although surgical staff members have the strength of knowing operative findings and the specific surgical risks of each patient, their busy schedules and prioritization of work performed in the operative theater mean they may fail to notice when a patient is off track.…”

The Effect of Daytime Surgical Hospitalists on Reducing Night Shift Physicians’ Workload

“…16 Moreover, the hospitalist system reduced the length of stay (9.6 versus 12.2 days; P < 0.001), the incidence of postoperative complications (44.6% versus 55.6%; P = 0.019), and the readmission rates (3.0% versus 6.9%; P = 0.046) of surgical patients. 17 In addition to clinical improvement, patients who were cared for by a hospitalist had more contact with a physician (β = 5.6, SE = 0.28; P < 0.0001). Furthermore, hospitalists spent significantly more time with their patients (β = 32.29, SE = 1.54; P < 0.0001).…”

New Concept of a Surgical Hospitalist: Early Experience of Managing the Admission, Critical Care, Trauma Surgery Team

“…Although five years have passed since the pilot project was implemented, surgical hospitalists in different hospitals operate in very diverse ways. Moreover, under the current fee-for-service system, the hospitalist system is operated mainly in large hospitals with sufficient human resources infrastructure [1,11]. In 2021, the total number of surgical hospitalists increased, but recruiting hospitalists in small and medium-sized hospitals or hospitals in provincial cities has remained challenging.…”

“…Finally, there is ambiguity in the division of roles between surgical hospitalists and medical residents. However, in most hospitals, the role of the resident has been replaced by the hospitalist who may not have the expertise or knowledge for making key decisions for the management of moderate-intensity patients [4,6,11].…”

“…In Korea, in line with the change of the three-year resident training system, the department of surgery applied a pilot project utilizing hospitalists in order to assess hospital costs and postoperative outcomes [11]. In the Department of Surgery, due to the nature of surgical treatment, the reduction of the training period and limitations associated with working hours are becoming a problem not only in the absence of treatment, but also in terms of the training of specialized surgeons [12,13].…”