SAN ANTONIO – Embedding a hospitalist in the trauma service reduces mortality and readmissions, according to a review from Christiana Care Health System’s Level 1 trauma center in Newark, Del.
Investigators wanted to see how their trauma hospitalist program – launched in 2013 – was working, so they matched 469 patients who were comanaged by a hospitalist in 2014 to 938 patients who were not, based on age, injury severity score, and comorbidities.
“We were pleasantly surprised to see a dramatic reduction in mortality [2.9% to 0.4%] and 30-day trauma-related readmissions [2.3% to 0.6%]” when hospitalists were involved with care, said Dr. Mark Cipolle, chief of trauma surgery at the center. The findings were statistically significant.
Dr. Mark Cipolle
More hospitalist patients were upgraded to the ICU [4.3% versus 2.1%], and hospitalist patients stayed in the hospital about a day and half longer. The increased ICU upgrades is probably from the extra vigilance trauma hospitalists bring to the team. As for length of stay, hospitalists probably “kept patients an extra day to tune up their diabetes, hypertension,” and other problems, and ensure they had good follow-up. “We strongly feel that many of these patients go home with their comorbidities better managed than when they came in,” Dr. Cipolle said at the annual scientific assembly of the Eastern Association for the Surgery of Trauma.
Hospitalists also seemed to improve patient satisfaction on surveys.
Christiana currently employs about eight trauma hospitalists in Newark who rotate through week-long shifts. They’ve become so central to trauma care there that Dr. Cipolle suspects it would be difficult to find patients without hospitalist management for a new control group.
His hospitalists tend to work with older patients and manage comorbidities, especially insulin-dependent diabetes, heart failure, other significant heart disease, and chronic renal injury. Trauma surgeons, meanwhile, manage injury-related issues, such as additional diagnostics and pain control.
There can be some disagreements when two attendings care for the same patient, but, overall, “we get along pretty darn well,” Dr. Cipolle said.
Hospitalists in the study made no significant difference in the frequency of cardiology, nephrology, neurology, or endocrinology consultations. There was no difference in the development of venous thromboembolism, pneumonia, stroke, urinary tract infection, bacteremia, or alcohol withdrawal.
The patients were about 72 years old, on average, with a mean injury severity score of 10. Roughly 8% were recovering from a stroke, about 10% had heart failure, a quarter were diabetic, and three-quarters were hypertensive.
Dr. Cipolle said he has no relevant disclosures.