AN INTERNIST JOINS THE SURGERY SERVICE - DOES COMANAGEMENT MAKE A DIFFERENCE

Objective: To determine the effect of internist comanagement of cardio thoracic surgical patients on patient outcome and resource utilization . Design: Before/after comparison. Setting: Tertiary care university-a ffiliated Veterans Affairs hospital. Patients: 165 patients (86 before the intervention and 79 after the intervention) undergoing cardiothor acic surgery. Intertventions: All patients were seen preoperatively an d at least daily through discharge by a comanaging staff internist who was a full-time member of the surgical team. Main outcome measures: L ength of stay, in-hospital mortality, and laboratory and radiology uti lization. Results: Significant shortening of postoperative length of s tay (18.1 days before and 12.1 days after, p = 0.05) and total length of stay (27.2 days before and 19.7 days after, p = 0.03) was noted. Th e in-hospital mortality rate for the patients undergoing surgery was 8 .1% before the intervention versus 2.5% afterward (p = 0.17). There we re significant reductions in the total number of x-rays (p = 0.02) and nearly significant reductions in total laboratory test utilization (p = 0.06). Referring physicians and surgeons both believed that the con tribution of the internist was important. Conclusions: The addition of an internist to the cardiothoracic surgery service at a tertiary care teaching center was associated with decreased resource utilization an d possible improved outcomes. Before becoming more widely adopted, thi s intervention deserves further exploration at other sites using stron ger study designs.