The “Surgeon on Service” Model for Timely, Economically Viable Inpatient Care of Tracheostomy Patients in Academic Pediatric Otolaryngology

Abstract

In this study, the presence of a rotating inpatient pediatric otolaryngologist was a productive approach to patient care associated with more timely performance of tracheostomy. Other benefits were an improved balance of service with education to trainees and a better perception of communication with consulting services.

Resource Utilization and Billing in a Resident‐Managed Inpatient Consult Service

“…The UCSF hospitalist model offers the benefit of faculty oversight of services to maximize billable wRVUs while simultaneously maintaining availability of faculty for emergent operative intervention when required 9 . The similar “surgeon on service” model implemented at Ann & Robert H. Lurie Children’s Hospital of Chicago also found that time to tracheostomy service provided was significantly decreased, communication with other services was improved, and an improved balance of service with resident education was also achieved 10 . Moreover, Adil et al 1 found at Boston Children’s Hospital that a chief of service (COS) model provided high‐quality and reliably available care by attending surgeons for high‐urgency consultations.…”

“…9 The similar ''surgeon on service'' model implemented at Ann & Robert H. Lurie Children's Hospital of Chicago also found that time to tracheostomy service provided was significantly decreased, communication with other services was improved, and an improved balance of service with resident education was also achieved. 10 Moreover, Adil et al 1 found at Boston Children's Hospital that a chief of service (COS) model provided high-quality and reliably available care by attending surgeons for high-urgency consultations. Louisiana State University in New Orleans retrospectively reviewed its implementation of a full-time otolaryngology hospitalist model, which showed an increase productivity of their specialists, charge capture, and billing in their department.…”

“…Russell et al 9 proposed an otolaryngology hospitalist model to increase faculty availability across a multisite academic medical center. Academic attending faculty are challenged to provide and maintain outpatient and elective surgical procedures while tending to inpatient service, emergency department, and resident education 10 . This leads to challenges with care coordination, timeliness of nonemergency operative care, and consistent participation in care and consultation at the attending surgeon level.…”

“…Academic attending faculty are challenged to provide and maintain outpatient and elective surgical procedures while tending to inpatient service, emergency department, and resident education. 10 This leads to challenges with care coordination, timeliness of nonemergency operative care, and consistent participation in care and consultation at the attending surgeon level. The University of California, San Francisco's (UCSF's) otolaryngology hospitalist model designates a single faculty member responsible for inpatient, emergency care, and acute care consultations over 1 week without outpatient clinical or elective operative responsibilities.…”

Efficient Postoperative Disposition Selection in Pediatric Otolaryngology Patients: A Novel Approach

“…Specifically, anesthesia coverage was split between the anesthesiologist on record and the anesthesia coordinator, and surgical coverage was shared between the primary surgeon and the inpatient surgeon on service. 20 Both teams were required to perform face-to-face handoffs to PACU nursing detailing the plan of care. Due to its nature as a major operational change, implementation of the Grey Zone model was limited in scale through designated hours of operation and a maximum daily allowance of two patients.…”