SHM Converge Scientific Abstract ePoster Gallery-Cardiothoracic Co-Management to Improve Efficiency and Strengthen the Surgical Partnership

Pdf Summary

Tampa General Hospital identified high variability and prolonged length of stay (LOS) for postoperative cardiothoracic (CT) surgery patients, with a 10.8-day average surgical LOS and 722 excess days in 2022. To improve efficiency, the hospitalist team partnered with CT surgery and critical care leadership to create a hospitalist co-management service (HCS) and standardized care pathway. The model aimed to reduce surgical LOS by one day and lower the LOS index by 0.3.<br /><br />The intervention included formalizing provider responsibilities, placing hospital medicine consults 24–48 hours before expected transfer from the CT ICU, and later expanding co-management to all CT surgery admissions. Additional supports were added through daily multidisciplinary rounds with case management, a pharmacy pathway to accelerate therapeutic warfarin dosing, and a hospitalist guide to CT surgery to improve familiarity with procedures and complications.<br /><br />In the first 90-day test of change, surgical LOS decreased by 0.7 days. In the second PDSA cycle, total LOS decreased by 0.33 days and surgical LOS again fell by 0.7 days. The team also saved an average of 6.04 days per month after the first two PDSAs. Patients staying longer than 14 days decreased despite higher case volume. Importantly, patient satisfaction (HCAPS), balancing metrics, readmission rates, and the Vizient LOS index were not negatively affected.<br /><br />Overall, the co-management approach improved efficiency and shortened postoperative stays without harming quality measures. The project highlighted the value of earlier hospitalist involvement in identifying medical issues and discharge barriers, and it is now being expanded into standardized preoperative and postoperative care pathways to reduce redundancy.

Asset Subtitle

Elizabeth Peek

Meta Tag

Author List Alyssa Kimble, Elizabeth Peek, Shanu Gupta

Category Research

Concept Cardiothoracic Hospitalist Co-management

Concept Surgical Length of Stay

Concept Efficiency

Concept Care Pathway

Concept Postoperative Care Pathway

Distinguished Non-Finalist

Presenter Organization University of South Florida

Presenting Author Elizabeth Peek

Track Quality Improvement

Keywords

Tampa General Hospital

cardiothoracic surgery

hospitalist co-management

length of stay

postoperative care

standardized care pathway

PDSA cycle

multidisciplinary rounds

warfarin dosing

patient satisfaction

Cardiothoracic Hospitalist Co-management

Surgical Length of Stay

Efficiency

Care Pathway

Postoperative Care Pathway