Effect of Comanagement With Internal Medicine on Hospital Stay of Patients Admitted to the Service of Otolaryngology

Ruiz, Eduardo Montero; Merino, A.; Rodríguez, T. Rivera; Sánchez, Marta García; Alonso, Rosa Agudo; Allende, J.M. Barbero

doi:10.1016/j.otoeng.2015.08.003

Cited by 6 publications

(10 citation statements)

References 16 publications

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“…Figure 1 outlines the process of study screening and selection for inclusion in this review. Of 6027 articles identified in initial searches, 73 underwent full-text assessment and 16 studies were identified for inclusion, including 1 (6%) RCT, 24 1 (6%) comparative cohort study, 25 and 14 (88%) pre-post studies, 23,[26][27][28][29][30][31][32][33][34][35][36][37][38] 3 (21%) of which included a concurrent control group. 26,32,33 A total of 3 pre-post studies (21%) were conducted at the same site using the same intervention but with different study dates and inclusion criteria, 27,34,35 so we included the study with the longest duration and largest range of outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…27 1 and details of the structure and process of the interventions in eTable 1 in the Supplement. Overall, 11 studies (79%) were from the US, [23][24][25][26][27][28]31,32,[36][37][38] 2 (14%) from the same investigator group in Spain, 29,30 and 1 (7%) from Canada 33 ; 6 (43%) studies were in orthopedic patients, and other specialties included neurosurgery, vascular surgery, colorectal surgery, thoracic surgery, ophthalmology, otolaryngology, and trauma surgery. A total of 5 studies (36%) were confined to emergency admissions only (hip fracture or trauma), 23,25,33,36,38 2 (14%) included elective admissions only, 24,31 and others included a mix of both emergency and elective cases, with 9 (64%) studying predominantly elective inpatients.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 12 studies (86%) were considered comanagement, 1 (7%) involved a comprehensive multidisciplinary program, of which 1 facet was the involvement of a consulting internist and/or geriatrician, 36 and 1 (7%) involved a primary medical service caring for patients undergoing trauma surgery and requesting surgical consultation if required. 23 A total of 5 studies (36%) involved an internist, [28][29][30]36,38 and the remainder involved hospitalists; 7 studies (50%) reported the involvement of an MDT. 25,27,32,[36][37][38] Overall, 6 studies (43%) had specific inclusion criteria for the service, 23,24,26,27,31,36 and 5 studies (36%) explicitly included preoperative assessment.…”

Section: Resultsmentioning

confidence: 99%

“…In the only RCT, Huddleston et al 24 reported no significant difference in LOS, although when they included discharge delay in their definition of LOS, a shorter mean LOS was reported (mean difference, −0.5 days; 95% CI, −0.8 to −0.1 days). In the nonrandomized studies, 5 (38%) reported a significant association with reduction in unadjusted mean LOS, 25,28,33,37,38 2 (15%) reported a significant increase, 23,27 and 4 (31%) reported no change 26,29,30,36 ; 2 (15%) did not report unadjusted mean LOS. 31,32…”

Section: Losmentioning

confidence: 97%

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Evaluation of Internal Medicine Physician or Multidisciplinary Team Comanagement of Surgical Patients and Clinical Outcomes

2020

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IMPORTANCE Older patients who undergo surgery may benefit from geriatrician comanagement. It is unclear whether other internal medicine (IM) physician involvement improves outcomes for adults who undergo surgery. OBJECTIVE To evaluate the association of IM physician involvement with clinical and health system outcomes compared with usual surgical care among adults who undergo surgery. DATA SOURCES MEDLINE, Embase, CINAHL, and CENTRAL databases were searched for studies published in English from database inception to April 2, 2019. STUDY SELECTION Prospective randomized or nonrandomized clinical studies comparing IM physician consultation or comanagement with usual surgical care were selected by consensus of 2 reviewers. DATA EXTRACTION AND SYNTHESIS Data were extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline by 2 authors independently. Intervention characteristics were described using existing indicators. Risk of bias was assessed using Risk of Bias 2.0 and Risk of Bias in Nonrandomized Studies of Interventions tools. Studies were pooled when appropriate in meta-analysis using random-effects models. Prespecified subgroups included IM physician-only vs multidisciplinary team interventions and patients undergoing elective vs emergency procedures. MAIN OUTCOMES AND MEASURESThe prespecified primary outcome was length of stay; other outcomes included 30-day readmissions, inpatient mortality, medical complications, functional outcomes, and costs. RESULTSOf 6027 records screened, 14 studies (with 1 randomized clinical trial) involving 35 800 patients (13 142 [36.7%] in intervention groups) were eligible for inclusion. Interventions varied substantially among studies and settings; most interventions described comanagement by a hospitalist or internist; 7 (50%) included a multidisciplinary team, and 9 (64%) studied predominantly patients who had elective procedures. Risk of bias in 10 studies (71%) was serious.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Losmentioning

confidence: 97%

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Evaluation of Internal Medicine Physician or Multidisciplinary Team Comanagement of Surgical Patients and Clinical Outcomes

2020

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“…The same favorable results have been reported by other studies that analyzed co-management programs in surgical wards. According to these studies, the implementation of co-management programs was associated with a reduction of medical complications, length of stay, 30-day readmissions, number of consultants, and cost of care [25][26][27].…”

Section: Evidence and Practice Of Co-management Modelsmentioning

confidence: 99%

Medical and surgical co-management – A strategy of improving the quality and outcomes of perioperative care

Fierbinţeanu-Braticevici

Raspe

Preda

et al. 2019

European Journal of Internal Medicine

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With the increase of ageing population, rates of chronic diseases and complex medical conditions, the management of high-risk surgical patients is likely to become a great concern in most countries. Considering all these factors, it is certainly rational and intuitive that internists should be included into a collaborative model of medical and surgical co-management, where their multi-potentiality and synthesis capacity require them to coordinate the multidisciplinary team and to be the leading agent of change. In this regard, our aim was to present the official position and approach of the Working Group on Professional Issues and Quality of Care of the European Federation of Internal Medicine (EFIM), for implementation of this strategy of care, encouraging internists to assume an important role and to provide continuity of multidisciplinary care, from the decision to operate through to rehabilitation and recovery. Moving from the traditional model of medical care of the surgical patients to the co-management model, from a reactive simple consultation to a new pro-active continued service, may optimize the quality and perioperative care, improving the survival, shortening hospital stays, replacing the old strategy of late and complication treatment to an early and preventive one.

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Surgical Comanagement by Hospitalists in Colorectal Surgery

Rohatgi

Wei

Grujic

et al. 2018

Journal of the American College of Surgeons

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Effect of Comanagement With Internal Medicine on Hospital Stay of Patients Admitted to the Service of Otolaryngology

Cited by 6 publications

References 16 publications

Evaluation of Internal Medicine Physician or Multidisciplinary Team Comanagement of Surgical Patients and Clinical Outcomes

Evaluation of Internal Medicine Physician or Multidisciplinary Team Comanagement of Surgical Patients and Clinical Outcomes

Medical and surgical co-management – A strategy of improving the quality and outcomes of perioperative care

Surgical Comanagement by Hospitalists in Colorectal Surgery

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