Introduction: The surgical hospitalist model is a way to improve efficiency and reduce complications and length of stay. We hypothesized that 24-hour in-house general surgeon coverage for urgent and emergent surgical consultation would improve safety, enhance quality, increase satisfaction, and lower costs.
Methods: We reviewed our program after one year and compared it to surgery performed in the previous year (single institution study). Before this program, in 2007, the general surgeons performed 513 acute cases; in 2008, the surgical hospitalists performed 711. The most commonly performed procedures were cholecystectomy, appendectomy, exploratory laparotomy, and incision and drainage of abscess. This amounted to 486 procedures in 2007, and 611 in 2008.
Results: There was a reduction in length of stay with the surgical hospitalists for appendectomies (3.0 to 1.9 days, p<0.0001), cholecystectomies (5.3 to 4.0 days, p=0.016), and incision and drainage (11.9 to 6.3 days, p=0.045). There was a significant reduction in total cost for appendectomies (-26%) and cholecystectomies (-12%). Losses for appendectomy in 2007 (-23%) converted to a per-case profit in 2008 (+23%).
Conclusion: The surgical hospitalist model improves physician lifestyle, improves timeliness of patient care, and provides a safe and effective means of caring for emergency surgical patients. We saw a reduction in costs that changed emergency surgery from a losing proposition to one that produced a potential profit for the facility.
© Acute Care Surgery Medical Group., Inc, and Surgical Affiliates Medical Group, Inc.
Figure 1: Number of Operative Procedures
Figure 2: Shift of Consults from Inpatient Ward to ED
Figure 3: Length of Stay
Figure 4: Percent of Patients with Complications
Figure 5: Cost per Case, Percent Change with Surgical Hospitalist Service
Figure 6: Profit Margin, Percent
