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Pediatric Hospital Medicine 2014: Co-Management in Pediatric Hospital Medicine



Sarah F. Denniston, Jack M. Percelay, David M. Pressel, David I. Rappaport, Elisabeth H. Villavicencio


Co-management is a growing area of pediatric HM involving both surgical and medical subspecialties. According to SHM, co-management is “shared responsibility, authority, and accountability for the care of a hospitalized patient across clinical specialties.”

Motivation for starting a co-management program may come from administrators due to quality, safety, or nursing concerns; surgeons or subspecialists driven by time or knowledge constraints; or from hospitalists looking to enhance patient safety, clinical skills, and practice development.

Pitfalls for hospitalists include patient “dumping,” care fragmentation, and working outside their scope of practice.

SHM identifies five keys to success for hospitalist co-management programs:

  1. Identify obstacles and challenges, including the program’s stakeholders, goals, risks and assumptions.
  2. Clarify roles and responsibilities for areas such as admission and discharge, communication, documentation and delineation of responsibilities. These should be specified in a service agreement.
  3. Identify champions, ideally to include a surgeon or subspecialist, hospitalist, administrator, and input from a family advisory council.
  4. Measure performance in areas such as length of stay, resource utilization, quality and safety metrics.
  5. Address financial issues. Most programs require some financial support to supplement billing revenue.

The AMA ethical guidelines for co-management arrangements state that the highest-quality care, not economic considerations, should be the guiding factor. Additionally, one physician should ultimately be responsible for the patient, there can be no kickbacks, and co-management arrangements need to be disclosed to the patient or family. TH

David Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

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