Preop Screening IDs Patients For Early Hospitalist Consult

MIAMI BEACH — Early identification of surgical patients who could benefit from postoperative consults minimizes complications, a pilot study has shown.

After an administrative review showed that hospitalists were being consulted late in the perioperative period, Dr. Elizabeth Marlow and Dr. Chad Whelan, both of the University of Chicago, designed a system to preoperatively identify patients at a higher risk of postoperative complications. “We were getting called a few days after we should have been consulted. This got me to think—is there a way to identify patients earlier to avoid complications?” Dr. Marlow said.

The researchers conducted the pilot study to see whether surgeons would be receptive to the offer to consult on these patients before their procedures, and if earlier consults would improve outcomes. To test the system, they contacted two high-volume orthopedic surgeons (doing primarily joint replacement surgery) at the university, Dr. Marlow said during a poster session at a meeting on perioperative medicine sponsored by the University of Miami.

Using patient data spanning 6 months, they screened 58, and identified 35, patients before elective surgery who could benefit from a consult. Then Dr. Marlow and Dr. Whelan accessed the patients' electronic medical records (EMRs) to identify risk factors—including age over 75, use of chronic anticoagulation, stage 3 kidney disease, diabetes, hypertension, and heart failure—associated with postoperative complications in orthopedic surgery patients. In addition, some consultations were suggested based on subjective assessment by the hospitalist or surgeon.

“We get a list of scheduled patients, and we review their labs or notes, sometimes 3 months in advance,” said Dr. Marlow, an instructor in the university's hospital medicine section. The surgeons, who can choose to opt out, are informed the week of the planned surgery via the EMR system that they have a patient scheduled who could benefit from a hospitalist consult.

The screening system helped fully identify patient medications preoperatively and has minimized the occurrence of postoperative delirium, for example, Dr. Marlow said. “We can also help with diabetes management and patients on long-term blood thinners.”

The researchers plan to refine their clinical criteria to improve the screening system. The pilot project helped them improve communication among hospitalists and consultative practices by members of their group.

They want to expand this service to other areas of the hospital and are negotiating with vascular surgeons and urologists. Cystectomy patients, for example, could benefit from preoperative screening and postoperative consult. “These patients tend to be older men and women, and they have a lot of comorbidities,” Dr. Marlow said.

Geriatricians at the medical center also are interested in this service. “A lot of orthopedic patients are older,” Dr. Marlow said, adding that some issues are better addressed by a geriatrician.

'We were getting called a few days after we should have been consulted.' DR. MARLOW

MIAMI BEACH — Early identification of surgical patients who could benefit from postoperative consults minimizes complications, a pilot study has shown.

After an administrative review showed that hospitalists were being consulted late in the perioperative period, Dr. Elizabeth Marlow and Dr. Chad Whelan, both of the University of Chicago, designed a system to preoperatively identify patients at a higher risk of postoperative complications. “We were getting called a few days after we should have been consulted. This got me to think—is there a way to identify patients earlier to avoid complications?” Dr. Marlow said.

The researchers conducted the pilot study to see whether surgeons would be receptive to the offer to consult on these patients before their procedures, and if earlier consults would improve outcomes. To test the system, they contacted two high-volume orthopedic surgeons (doing primarily joint replacement surgery) at the university, Dr. Marlow said during a poster session at a meeting on perioperative medicine sponsored by the University of Miami.

Using patient data spanning 6 months, they screened 58, and identified 35, patients before elective surgery who could benefit from a consult. Then Dr. Marlow and Dr. Whelan accessed the patients' electronic medical records (EMRs) to identify risk factors—including age over 75, use of chronic anticoagulation, stage 3 kidney disease, diabetes, hypertension, and heart failure—associated with postoperative complications in orthopedic surgery patients. In addition, some consultations were suggested based on subjective assessment by the hospitalist or surgeon.

“We get a list of scheduled patients, and we review their labs or notes, sometimes 3 months in advance,” said Dr. Marlow, an instructor in the university's hospital medicine section. The surgeons, who can choose to opt out, are informed the week of the planned surgery via the EMR system that they have a patient scheduled who could benefit from a hospitalist consult.

The screening system helped fully identify patient medications preoperatively and has minimized the occurrence of postoperative delirium, for example, Dr. Marlow said. “We can also help with diabetes management and patients on long-term blood thinners.”

The researchers plan to refine their clinical criteria to improve the screening system. The pilot project helped them improve communication among hospitalists and consultative practices by members of their group.

They want to expand this service to other areas of the hospital and are negotiating with vascular surgeons and urologists. Cystectomy patients, for example, could benefit from preoperative screening and postoperative consult. “These patients tend to be older men and women, and they have a lot of comorbidities,” Dr. Marlow said.

Geriatricians at the medical center also are interested in this service. “A lot of orthopedic patients are older,” Dr. Marlow said, adding that some issues are better addressed by a geriatrician.

'We were getting called a few days after we should have been consulted.' DR. MARLOW

MIAMI BEACH — Early identification of surgical patients who could benefit from postoperative consults minimizes complications, a pilot study has shown.

After an administrative review showed that hospitalists were being consulted late in the perioperative period, Dr. Elizabeth Marlow and Dr. Chad Whelan, both of the University of Chicago, designed a system to preoperatively identify patients at a higher risk of postoperative complications. “We were getting called a few days after we should have been consulted. This got me to think—is there a way to identify patients earlier to avoid complications?” Dr. Marlow said.

The researchers conducted the pilot study to see whether surgeons would be receptive to the offer to consult on these patients before their procedures, and if earlier consults would improve outcomes. To test the system, they contacted two high-volume orthopedic surgeons (doing primarily joint replacement surgery) at the university, Dr. Marlow said during a poster session at a meeting on perioperative medicine sponsored by the University of Miami.

Using patient data spanning 6 months, they screened 58, and identified 35, patients before elective surgery who could benefit from a consult. Then Dr. Marlow and Dr. Whelan accessed the patients' electronic medical records (EMRs) to identify risk factors—including age over 75, use of chronic anticoagulation, stage 3 kidney disease, diabetes, hypertension, and heart failure—associated with postoperative complications in orthopedic surgery patients. In addition, some consultations were suggested based on subjective assessment by the hospitalist or surgeon.

“We get a list of scheduled patients, and we review their labs or notes, sometimes 3 months in advance,” said Dr. Marlow, an instructor in the university's hospital medicine section. The surgeons, who can choose to opt out, are informed the week of the planned surgery via the EMR system that they have a patient scheduled who could benefit from a hospitalist consult.

The screening system helped fully identify patient medications preoperatively and has minimized the occurrence of postoperative delirium, for example, Dr. Marlow said. “We can also help with diabetes management and patients on long-term blood thinners.”

The researchers plan to refine their clinical criteria to improve the screening system. The pilot project helped them improve communication among hospitalists and consultative practices by members of their group.

They want to expand this service to other areas of the hospital and are negotiating with vascular surgeons and urologists. Cystectomy patients, for example, could benefit from preoperative screening and postoperative consult. “These patients tend to be older men and women, and they have a lot of comorbidities,” Dr. Marlow said.

Geriatricians at the medical center also are interested in this service. “A lot of orthopedic patients are older,” Dr. Marlow said, adding that some issues are better addressed by a geriatrician.

'We were getting called a few days after we should have been consulted.' DR. MARLOW