Potential role of comanagement in "rescue" of surgical patients.

OBJECTIVES: To evaluate the effect of medical comanagement on outcomes of hospitalized surgical patients who had postoperative complications. STUDY DESIGN: Retrospective cohort study. METHODS: We used clinical and administrative data at a large urban hospital to conduct a cohort study of select surgical hospitalizations in 2008 and 2009. We identified patients who suffered postoperative complications using measures developed by the University Health System Consortium. Bivariate and multivariate regression analyses were used to determine the associations of postoperative comanagement with inpatient mortality, length of stay, and cost in surgical patients who had postoperative complications. RESULTS: From 21,728 total surgical hospitalizations, we identified 4040 hospitalizations involving primary procedures (mainly orthopedic and neurosurgical) that were associated with comanagement at least 25% of the time. After excluding cases with missing data, 501 hospitalizations (13.8%) involved a patient who suffered at least 1 postoperative complication. Patient characteristics between the comanaged (n = 297) and non-comanaged (n = 204) hospitalizations were well matched. Medical comanagement was associated with fewer in-hospital deaths (odds ratio 0.23, 95% confidence interval 0.05-0.99) in adjusted analysis. Comanaged compared with non-comanaged hospitalizations were associated with shorter stay (-2.6 days, P <.01) without significant differences in total cost. CONCLUSIONS: Comanagement of patients who had perioperative complications was associated with lower mortality, suggesting that comanagement may facilitate effective rescue among medically complex surgical patients.

Assessing patient perceptions of hospitalist communication skills using the Communication Assessment Tool (CAT).

BACKGROUND: Hospitalists care for an increasing percentage of hospitalized patients, yet evaluations of patient perceptions of hospitalists' communication skills are lacking. OBJECTIVE: Assess hospitalist communication skills using the Communication Assessment Tool (CAT). METHODS: A cross-sectional study of patients, age 18 or older, admitted to the hospital medicine service at an urban, academic medical center with 873 beds. Thirty-five hospitalists assigned to both direct care and teaching service were assessed. MEASUREMENTS: Hospitalist communication was measured with the CAT. The 14-item survey, written at a fourth grade level, measures responses along a 5-point scale ("poor" to "excellent"). Scores are reported as a percentage of "excellent" responses. RESULTS: We analyzed 700 patient surveys (20 for each of 35 hospitalists). The proportion of excellent ratings for each hospitalist ranged from 38.5% to 73.5%, with an average of 59.1% excellent (SD=9.5). Highest ratings on individual CAT items were for treating the patient with respect, letting the patient talk without interruptions, and talking in terms the patient can understand. Lowest ratings were for involving the patient in decisions as much as he or she wanted, encouraging the patient to ask questions, and greeting the patient in a way that made him or her feel comfortable. Overall scale reliability was high (Cronbach's alpha = 0.97). CONCLUSIONS: The CAT can be used to gauge patient perceptions of hospitalist communication skills. Many hospitalists may benefit from targeted training to improve communication skills, particularly in the areas of encouraging questions and involving patients in decision making.