Teamwork is central to high-quality medical care. This statement holds even more so for the perioperative setting, in which surgeons, anesthesiologists, primary care and specialty physicians collaborate in order to decide on and subsequently deliver essential care to the patient. In dialogue on the perioperative cycle, it is oft-assumed that analysis ends when the patient has left the operating room. However, the post-operative stage can be significantly essential with respect to the patient’s recovery time and thus return to daily life. In discussing this issue, it is useful to note that hospitalists are critical healthcare providers for patients who transition to in-patient care following the operation. Furthermore, collaboration between anesthesiologists and hospitalists is beneficial in order to improve delivery of care from intake to discharge.
Hospitalists are medical specialists who have underwent specific training on in-patient care for patients in a hospital setting. To pursue hospital medicine, medical college graduates must enter an internal medicine residency program. Certain residencies may include a focus on hospital medicine, such as including hospitalist rotations or providing opportunities for residents to conduct hospital-oriented research. After residency, interested graduates can elect to complete a hospitalist fellowship1. Fellowships will range in clinical responsibilities, but many shall include a research element that focuses on a hospitalist sub-topic such as patient safety, post-operative care, or quality. With this specific training, hospitalists are highly knowledgeable about in-patient care following surgery.
Hospitalists and anesthesiologists often work together in the pre- and post-perioperative time periods, therefore allowing the surgeon to focus on the operation at-hand2. In certain cases, the role of the anesthesiologist may have similarities with that of the hospitalist. For example, the development of the Perioperative Surgical Home model encourages anesthesiologists to assume responsibility for pre-operative planning and patient management, in addition to post-operative acute care. A subset of anesthesiologists may have also underwent training for intensive care or patient sub-populations, therefore these anesthesia providers are viable to deliver care in this setting.
Given this landscape, academic medical centers have explored the viability for anesthesiologists to serve as leaders in hospitalist care teams. Recently, researchers from Loma Linda University School of Medicine completed an intervention in which anesthesiologists co-managed patients registered for urologic surgery, selecting from a subset of anesthesiologists who had previously completed hospitalist training3. It was evidenced that the length of stay decreased from two to one day post-operation when anesthesiologists led the hospitalist care team. In addition, complication rates and direct patient care costs also decreased to statistical significance in the intervention cohort. The researchers concluded that a formal program for anesthesiologists to be involved in, and further lead patient management services, is associated with patient safety, clinical efficacy, and global cost benefits to the system. Dovetailing off this study, additional medical centers have agreed that anesthesiologists form an essential component of the post-operative stage of the perioperative cycle and provide value as leaders in the field.
Researched methods of delivering care will continue to explore how anesthesiologists can continue to engage in multiple aspects of the perioperative cycle. Post-operative care, importantly, is essential for patient safety objectives, as well as returning patients to a healthy life.
1. Holliman, Kathy. “Hospitalist Fellowships Offer Clinical, Research, or Leadership Training.” ACP Hospitalist, 15 Sept. 2015, acphospitalist.org/archives/2015/09/hospitalist-fellowships.htm.
2. Adesanya, Adebola O and Girish P Joshi. “Hospitalists and anesthesiologists as perioperative physicians: Are their roles complementary?” Proceedings (Baylor University. Medical Center) vol. 20,2 (2007): 140-2.
3. Stier, Gary et al. “Anesthesiologists as perioperative hospitalists and outcomes in patients undergoing major urologic surgery: a historical prospective, comparative effectiveness study” Perioperative medicine (London, England)< vol. 7 13. 19 Jun. 2018, doi:10.1186/s13741-018-0090-y