Pediatric hospitalist comanagement of spinal fusion surgery patients
BACKGROUND: There are no published studies of hospitalist comanagement of pediatric surgical patients. OBJECTIVES: (1) To describe comanagement activities; (2) to determine the association of hospitalist comanagement with length of stay (LOS) following spinal fusion surgery DESIGN: Retrospective ana...
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| Veröffentlicht in: | Journal of hospital medicine 2007-01, Vol.2 (1), p.23-30 |
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| creator | Simon, Tamara D. Eilert, Robert Dickinson, L. Miriam Kempe, Allison Benefield, Elise Berman, Stephen |
| description | BACKGROUND:
There are no published studies of hospitalist comanagement of pediatric surgical patients.
OBJECTIVES:
(1) To describe comanagement activities; (2) to determine the association of hospitalist comanagement with length of stay (LOS) following spinal fusion surgery
DESIGN:
Retrospective analysis of the surgeons' log.
SETTING:
Tertiary‐care pediatric hospital.
PATIENTS:
Patients who underwent initial spinal fusion surgery (n = 759) between July 2000 and October 2005.
INTERVENTION:
Hospitalist pre‐ and perioperative evaluation and management of medically complex patients (from December 2004 to October 2005).
MEASUREMENTS:
Log‐transformed LOS and trend in LOS by piecewise regression were measured, adjusting for patient covariates and clustering by surgeon.
RESULTS:
After December 2004, 12% of all spinal fusion surgery patients (14 of 115) were comanaged by a hospitalist. Nine‐three percent (13 of 14) of comanaged patients had neuromuscular scoliosis, and comanaged patients represented 37% (13 of 35) of all neuromuscular patients. Mean LOS for all spinal fusion surgeries decreased from 6.5 days (95% CI: 6.2–6.7) to 4.8 days (95% CI: 4.5–5.1) after December 2004. Mean LOS decreased more for neuromuscular patients (8.6 days [95% CI: 8.0– 9.2] to 6.2 days [95% CI: 5.5–6.9]) than for idiopathic patients (5.2 days [95% CI: 5.0–5.4] to 4.1 days [95% CI: 3.9–4.4]). Variability in LOS also decreased significantly for both groups. Prior to hospitalist comanagement, there was no change in adjusted LOS over time. After December 2004, there was a significant decline in average adjusted LOS (neuromuscular slope = −0.23 to −0.31 days/month, P = .0075; idiopathic slope = −0.10 to −0.12 days/month; P = .0007).
CONCLUSIONS:
The introduction of selective hospitalist comanagement of pediatric spinal fusion surgery patients was associated with significant decreases in LOS and variability in LOS. Journal of Hospital Medicine 2007;2:23–30. © 2007 Society of Hospital Medicine. |
| doi_str_mv | 10.1002/jhm.144 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69037609</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69037609</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3864-d4c4ae8884b269287da8fa93d502e7c34dfdb37651849c070d38f49387f0f7483</originalsourceid><addsrcrecordid>eNp10E1PwyAAxnFiNG5O4zcwPenBdNIChR7NdJtmvhxmlnghjMLG7JvQRvftxXTqyRMk_HgOfwBOIziMIIyvNutiGGG8B_oRISgkCUz2f-4kjXvgyLkNhBgxgg9BL6IxxRCTPrh5VpkRjTUyWFeuNo3IjWsCWRWiFCtVqLIJKh34l1LkgW6dqcrAtXal7DaoRWM8cMfgQIvcqZPdOQAv49v5aBrOniZ3o-tZKBFLcJhhiYVijOFlnKQxo5lgWqQoIzBWVCKc6WyJaEIihlMJKcwQ0zhFjGqoKWZoAM673dpW761yDS-MkyrPRamq1vEkhf47TD286KC0lXNWaV5bUwi75RHk38G4D8Z9MC_PdpPtslDZn9sV8uCyAx8mV9v_dvj99KGbCzvtI6rPXy3sG08oooQvHid8PEfpeIFfOUFflPGC6Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>69037609</pqid></control><display><type>article</type><title>Pediatric hospitalist comanagement of spinal fusion surgery patients</title><source>MEDLINE</source><source>Wiley Journals</source><creator>Simon, Tamara D. ; Eilert, Robert ; Dickinson, L. Miriam ; Kempe, Allison ; Benefield, Elise ; Berman, Stephen</creator><creatorcontrib>Simon, Tamara D. ; Eilert, Robert ; Dickinson, L. Miriam ; Kempe, Allison ; Benefield, Elise ; Berman, Stephen</creatorcontrib><description>BACKGROUND:
There are no published studies of hospitalist comanagement of pediatric surgical patients.
OBJECTIVES:
(1) To describe comanagement activities; (2) to determine the association of hospitalist comanagement with length of stay (LOS) following spinal fusion surgery
DESIGN:
Retrospective analysis of the surgeons' log.
SETTING:
Tertiary‐care pediatric hospital.
PATIENTS:
Patients who underwent initial spinal fusion surgery (n = 759) between July 2000 and October 2005.
INTERVENTION:
Hospitalist pre‐ and perioperative evaluation and management of medically complex patients (from December 2004 to October 2005).
MEASUREMENTS:
Log‐transformed LOS and trend in LOS by piecewise regression were measured, adjusting for patient covariates and clustering by surgeon.
RESULTS:
After December 2004, 12% of all spinal fusion surgery patients (14 of 115) were comanaged by a hospitalist. Nine‐three percent (13 of 14) of comanaged patients had neuromuscular scoliosis, and comanaged patients represented 37% (13 of 35) of all neuromuscular patients. Mean LOS for all spinal fusion surgeries decreased from 6.5 days (95% CI: 6.2–6.7) to 4.8 days (95% CI: 4.5–5.1) after December 2004. Mean LOS decreased more for neuromuscular patients (8.6 days [95% CI: 8.0– 9.2] to 6.2 days [95% CI: 5.5–6.9]) than for idiopathic patients (5.2 days [95% CI: 5.0–5.4] to 4.1 days [95% CI: 3.9–4.4]). Variability in LOS also decreased significantly for both groups. Prior to hospitalist comanagement, there was no change in adjusted LOS over time. After December 2004, there was a significant decline in average adjusted LOS (neuromuscular slope = −0.23 to −0.31 days/month, P = .0075; idiopathic slope = −0.10 to −0.12 days/month; P = .0007).
CONCLUSIONS:
The introduction of selective hospitalist comanagement of pediatric spinal fusion surgery patients was associated with significant decreases in LOS and variability in LOS. Journal of Hospital Medicine 2007;2:23–30. © 2007 Society of Hospital Medicine.</description><identifier>ISSN: 1553-5592</identifier><identifier>EISSN: 1553-5606</identifier><identifier>DOI: 10.1002/jhm.144</identifier><identifier>PMID: 17274045</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject><![CDATA[Adolescent ; Child ; Colorado ; comanagement ; Hospitalists - organization & administration ; Hospitalists - statistics & numerical data ; Humans ; Length of Stay ; orthopedics ; Orthopedics - organization & administration ; Orthopedics - statistics & numerical data ; Patient Care Team - organization & administration ; Patient Care Team - statistics & numerical data ; pediatrics ; Pediatrics - organization & administration ; Pediatrics - statistics & numerical data ; Postoperative Care - methods ; Postoperative Care - statistics & numerical data ; Preoperative Care - methods ; Preoperative Care - statistics & numerical data ; Retrospective Studies ; Spinal Fusion - statistics & numerical data ; spine fusion]]></subject><ispartof>Journal of hospital medicine, 2007-01, Vol.2 (1), p.23-30</ispartof><rights>Copyright © 2007 Society of Hospital Medicine</rights><rights>(c) 2007 Society of Hospital Medicine.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3864-d4c4ae8884b269287da8fa93d502e7c34dfdb37651849c070d38f49387f0f7483</citedby><cites>FETCH-LOGICAL-c3864-d4c4ae8884b269287da8fa93d502e7c34dfdb37651849c070d38f49387f0f7483</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjhm.144$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjhm.144$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17274045$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Simon, Tamara D.</creatorcontrib><creatorcontrib>Eilert, Robert</creatorcontrib><creatorcontrib>Dickinson, L. Miriam</creatorcontrib><creatorcontrib>Kempe, Allison</creatorcontrib><creatorcontrib>Benefield, Elise</creatorcontrib><creatorcontrib>Berman, Stephen</creatorcontrib><title>Pediatric hospitalist comanagement of spinal fusion surgery patients</title><title>Journal of hospital medicine</title><addtitle>J. Hosp. Med</addtitle><description>BACKGROUND:
There are no published studies of hospitalist comanagement of pediatric surgical patients.
OBJECTIVES:
(1) To describe comanagement activities; (2) to determine the association of hospitalist comanagement with length of stay (LOS) following spinal fusion surgery
DESIGN:
Retrospective analysis of the surgeons' log.
SETTING:
Tertiary‐care pediatric hospital.
PATIENTS:
Patients who underwent initial spinal fusion surgery (n = 759) between July 2000 and October 2005.
INTERVENTION:
Hospitalist pre‐ and perioperative evaluation and management of medically complex patients (from December 2004 to October 2005).
MEASUREMENTS:
Log‐transformed LOS and trend in LOS by piecewise regression were measured, adjusting for patient covariates and clustering by surgeon.
RESULTS:
After December 2004, 12% of all spinal fusion surgery patients (14 of 115) were comanaged by a hospitalist. Nine‐three percent (13 of 14) of comanaged patients had neuromuscular scoliosis, and comanaged patients represented 37% (13 of 35) of all neuromuscular patients. Mean LOS for all spinal fusion surgeries decreased from 6.5 days (95% CI: 6.2–6.7) to 4.8 days (95% CI: 4.5–5.1) after December 2004. Mean LOS decreased more for neuromuscular patients (8.6 days [95% CI: 8.0– 9.2] to 6.2 days [95% CI: 5.5–6.9]) than for idiopathic patients (5.2 days [95% CI: 5.0–5.4] to 4.1 days [95% CI: 3.9–4.4]). Variability in LOS also decreased significantly for both groups. Prior to hospitalist comanagement, there was no change in adjusted LOS over time. After December 2004, there was a significant decline in average adjusted LOS (neuromuscular slope = −0.23 to −0.31 days/month, P = .0075; idiopathic slope = −0.10 to −0.12 days/month; P = .0007).
CONCLUSIONS:
The introduction of selective hospitalist comanagement of pediatric spinal fusion surgery patients was associated with significant decreases in LOS and variability in LOS. Journal of Hospital Medicine 2007;2:23–30. © 2007 Society of Hospital Medicine.</description><subject>Adolescent</subject><subject>Child</subject><subject>Colorado</subject><subject>comanagement</subject><subject>Hospitalists - organization & administration</subject><subject>Hospitalists - statistics & numerical data</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>orthopedics</subject><subject>Orthopedics - organization & administration</subject><subject>Orthopedics - statistics & numerical data</subject><subject>Patient Care Team - organization & administration</subject><subject>Patient Care Team - statistics & numerical data</subject><subject>pediatrics</subject><subject>Pediatrics - organization & administration</subject><subject>Pediatrics - statistics & numerical data</subject><subject>Postoperative Care - methods</subject><subject>Postoperative Care - statistics & numerical data</subject><subject>Preoperative Care - methods</subject><subject>Preoperative Care - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Spinal Fusion - statistics & numerical data</subject><subject>spine fusion</subject><issn>1553-5592</issn><issn>1553-5606</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10E1PwyAAxnFiNG5O4zcwPenBdNIChR7NdJtmvhxmlnghjMLG7JvQRvftxXTqyRMk_HgOfwBOIziMIIyvNutiGGG8B_oRISgkCUz2f-4kjXvgyLkNhBgxgg9BL6IxxRCTPrh5VpkRjTUyWFeuNo3IjWsCWRWiFCtVqLIJKh34l1LkgW6dqcrAtXal7DaoRWM8cMfgQIvcqZPdOQAv49v5aBrOniZ3o-tZKBFLcJhhiYVijOFlnKQxo5lgWqQoIzBWVCKc6WyJaEIihlMJKcwQ0zhFjGqoKWZoAM673dpW761yDS-MkyrPRamq1vEkhf47TD286KC0lXNWaV5bUwi75RHk38G4D8Z9MC_PdpPtslDZn9sV8uCyAx8mV9v_dvj99KGbCzvtI6rPXy3sG08oooQvHid8PEfpeIFfOUFflPGC6Q</recordid><startdate>200701</startdate><enddate>200701</enddate><creator>Simon, Tamara D.</creator><creator>Eilert, Robert</creator><creator>Dickinson, L. Miriam</creator><creator>Kempe, Allison</creator><creator>Benefield, Elise</creator><creator>Berman, Stephen</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200701</creationdate><title>Pediatric hospitalist comanagement of spinal fusion surgery patients</title><author>Simon, Tamara D. ; Eilert, Robert ; Dickinson, L. Miriam ; Kempe, Allison ; Benefield, Elise ; Berman, Stephen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3864-d4c4ae8884b269287da8fa93d502e7c34dfdb37651849c070d38f49387f0f7483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adolescent</topic><topic>Child</topic><topic>Colorado</topic><topic>comanagement</topic><topic>Hospitalists - organization & administration</topic><topic>Hospitalists - statistics & numerical data</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>orthopedics</topic><topic>Orthopedics - organization & administration</topic><topic>Orthopedics - statistics & numerical data</topic><topic>Patient Care Team - organization & administration</topic><topic>Patient Care Team - statistics & numerical data</topic><topic>pediatrics</topic><topic>Pediatrics - organization & administration</topic><topic>Pediatrics - statistics & numerical data</topic><topic>Postoperative Care - methods</topic><topic>Postoperative Care - statistics & numerical data</topic><topic>Preoperative Care - methods</topic><topic>Preoperative Care - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Spinal Fusion - statistics & numerical data</topic><topic>spine fusion</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Simon, Tamara D.</creatorcontrib><creatorcontrib>Eilert, Robert</creatorcontrib><creatorcontrib>Dickinson, L. Miriam</creatorcontrib><creatorcontrib>Kempe, Allison</creatorcontrib><creatorcontrib>Benefield, Elise</creatorcontrib><creatorcontrib>Berman, Stephen</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of hospital medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Simon, Tamara D.</au><au>Eilert, Robert</au><au>Dickinson, L. Miriam</au><au>Kempe, Allison</au><au>Benefield, Elise</au><au>Berman, Stephen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pediatric hospitalist comanagement of spinal fusion surgery patients</atitle><jtitle>Journal of hospital medicine</jtitle><addtitle>J. Hosp. Med</addtitle><date>2007-01</date><risdate>2007</risdate><volume>2</volume><issue>1</issue><spage>23</spage><epage>30</epage><pages>23-30</pages><issn>1553-5592</issn><eissn>1553-5606</eissn><abstract>BACKGROUND:
There are no published studies of hospitalist comanagement of pediatric surgical patients.
OBJECTIVES:
(1) To describe comanagement activities; (2) to determine the association of hospitalist comanagement with length of stay (LOS) following spinal fusion surgery
DESIGN:
Retrospective analysis of the surgeons' log.
SETTING:
Tertiary‐care pediatric hospital.
PATIENTS:
Patients who underwent initial spinal fusion surgery (n = 759) between July 2000 and October 2005.
INTERVENTION:
Hospitalist pre‐ and perioperative evaluation and management of medically complex patients (from December 2004 to October 2005).
MEASUREMENTS:
Log‐transformed LOS and trend in LOS by piecewise regression were measured, adjusting for patient covariates and clustering by surgeon.
RESULTS:
After December 2004, 12% of all spinal fusion surgery patients (14 of 115) were comanaged by a hospitalist. Nine‐three percent (13 of 14) of comanaged patients had neuromuscular scoliosis, and comanaged patients represented 37% (13 of 35) of all neuromuscular patients. Mean LOS for all spinal fusion surgeries decreased from 6.5 days (95% CI: 6.2–6.7) to 4.8 days (95% CI: 4.5–5.1) after December 2004. Mean LOS decreased more for neuromuscular patients (8.6 days [95% CI: 8.0– 9.2] to 6.2 days [95% CI: 5.5–6.9]) than for idiopathic patients (5.2 days [95% CI: 5.0–5.4] to 4.1 days [95% CI: 3.9–4.4]). Variability in LOS also decreased significantly for both groups. Prior to hospitalist comanagement, there was no change in adjusted LOS over time. After December 2004, there was a significant decline in average adjusted LOS (neuromuscular slope = −0.23 to −0.31 days/month, P = .0075; idiopathic slope = −0.10 to −0.12 days/month; P = .0007).
CONCLUSIONS:
The introduction of selective hospitalist comanagement of pediatric spinal fusion surgery patients was associated with significant decreases in LOS and variability in LOS. Journal of Hospital Medicine 2007;2:23–30. © 2007 Society of Hospital Medicine.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>17274045</pmid><doi>10.1002/jhm.144</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Child Colorado comanagement Hospitalists - organization & administration Hospitalists - statistics & numerical data Humans Length of Stay orthopedics Orthopedics - organization & administration Orthopedics - statistics & numerical data Patient Care Team - organization & administration Patient Care Team - statistics & numerical data pediatrics Pediatrics - organization & administration Pediatrics - statistics & numerical data Postoperative Care - methods Postoperative Care - statistics & numerical data Preoperative Care - methods Preoperative Care - statistics & numerical data Retrospective Studies Spinal Fusion - statistics & numerical data spine fusion |
| title | Pediatric hospitalist comanagement of spinal fusion surgery patients |
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