In 1996, Leon Owens, MD, FACS, started to design a surgical hospitalist program to assist with hospitals’ surgical call coverage needs. Over a five year study period from 2007 through 2011, he found that this new model produced statistically significant reductions in length of stay, complication rates, and hospital costs. Now Dr. Owens and the management company Surgical Affiliates Management Group, Inc. (SAMGI) are bringing this model to hospitals all over the United States.
During the last two decades, thousands of internal medicine physicians made the leap from clinic-based primary care practices to full-time hospitalist positions. For many physicians, the competing demands of clinical practice and constant hospital call coverage proved too burdensome to do both all the time. Dr. Owens, CEO of SAMGI, believes this phenomenon is now happening to surgeons.
“With time, you will see what we saw with medical hospitalists,” Dr. Owens says about surgical hospitalists. “It will become routine—a specialty of its own. The acute care model, the idea of being around for emergencies is very specific. If you do nothing but emergent gall bladders all the time, it is different than elective gall bladders.”
One perceived hurdle to the surgical hospitalist model is the fear that community surgeons will have their practices cannibalized by the surgical hospitalists. Dr. Owens says SAMGI always embraces local surgeons who want to participate by taking call, but surgical hospitalists have not demonstrated a negative effect on the elective operative volumes of community physicians.
“Instead of trying to do both elective and emergency surgeries and getting pulled in fifty directions, there are financial savings to be enjoyed from committed surgical hospitalists who are happy to take patients out of the ER,” says Dr. Owens. “You can’t do both efficiently. It is frustrating for the physicians and for patients.”
The findings from their study, Sustainability and Success of the Acute Care Surgery Model in the Nontrauma Setting, were published in the July issue of the Journal of the American College of Surgeons. This study used the first year as a control, and compared outcomes and costs with the results from the implemented surgical hospitalist program over the next four years. For the intervention periods, complications, length of stay, and hospital costs were lower.
Overall surgical hospitalist service:
- fewer overall complications (21% to 12%, p < 0.0001)
- shorter length of stay (6.5 days to 5.7 days, p = 0.0016)
- hospital costs fell from $12,009 to $8,306 (p < 0.0001)
“With this model the physicians are rested, and the NPs and PAs are always available to communicate with patients and their families.”
Post-appendectomy:
- complications decreased (13% to 3.7%, p < 0.0001)
- length of stay was shorter (3.0 to 2.3 days, p < 0.0001)
- hospital costs decreased from $9,392 to $5,872 (p < 0.0001)
Post-cholecystectomy:
- complications decreased (21% to 9%, p = 0.012)
- length of stay was shorter (5.3 to 3.8 days, p = 0.0004)
- hospital costs decreased from $12,526 to $9,348 (p < 0.0001)
The SAMGI program model involves two 24/7 shifts per surgeon per week, as well as nurse practitioners (NPs) and physician assistants (PAs) staffing the overlaps during the swing shifts. Depending on a client hospital’s size, three-and-half full-time-equivalent surgical hospitalists can usually service continuous emergency coverage comfortably over the course of a year. The NPs and PAs also serve an important purpose by ensuring there is continuity and smooth handoffs for patients.
“The NPs and PAs are there continuously,” says Dr. Owens. “They are the glue of the program. It is a concierge-like service. We want the patients to get something special. With this model the physicians are rested, and the NPs and PAs are always available to communicate with patients and their families.”
Quality measurements also play a prominent role in SAMGI’s surgical hospitalist programs. SAMGI has conferences every month to review every case and complication in detail. Hospital clients receive robust quality performance dashboards. In addition to popular quality metrics, like the Surgical Care Improvement Project (SCIP) measures, SAMGI also focuses on the custom-tailored metrics that are important to each hospital client. Surgeons’ bonuses are based on the achievement of pre-defined quality performance measures.
“I think what we’re doing is the future,” says Dr. Owens. “I think it is only going to grow as hospitals look for more efficient and collaborative emergent surgical coverage.”
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Surgical Affiliates Management Group, Inc. (SAMGI) is based in Sacramento, California. For inquiries, please contact SAMGI at (916) 441-0400 or by email at info@samgi.com.