Effective medicine is practiced in teams. This truth holds particularly in the surgical setting, where surgeons, anesthesiologists, internists and specialists work in tandem to plan and deliver the appropriate care to the patient. In discussions of the perioperative cycle, dialogue often diminishes when the patient has left the operating room. However, this post-operative time can be crucial in terms of the patient’s recovery and subsequent return to daily life. To address this need, hospitalists are essential practitioners for patients who have entered in-patient care following surgery. Moreover, anesthesiologists and hospitalists can collaborate in order to enhance perioperative care from intake to discharge.
Hospitalists are physicians who are dedicated to providing in-patient care for patients. To become a hospitalist, medical graduates must complete an internal medicine residency program. Specific residencies may include an emphasis on hospital medicine, by including hospitalist rotations or allowing residents to become involved with tailored research. Following residency, interested individuals can seek to complete a hospitalist fellowship1. Fellowships vary in terms of clinical responsibilities, but many include a research component that focuses on a sub-topic such as patient safety, post-operative care, or quality. Due to this specific training, hospitalists convey a valuable trove of knowledge in the surgical setting.
Hospitalists and anesthesiologists often collaborate in the perioperative setting, thus allowing the surgeon to focus on the surgery2. In many cases, the role of the anesthesiologist may overlap with that of the hospitalist. Particularly with the development of the Perioperative Surgical Home model, many anesthesiologists assume responsibility for pre-operative patient management and planning, as well as post-operative acute care. A subset of anesthesiologists have also completed training in intensive care or other fellowship training, hence these sub-specialists have the background to provide expert care to specific patient populations.
With this in mind, many hospitals have explored the option of anesthesiologists serving as hospitalists. A recent study from Loma Linda University School of Medicine introduced an intervention wherein anesthesiologists co-managed patients undergoing urologic surgery, selecting a cohort of anesthesiologists who previously completed additional training3. It was found that length of stay decreased from two to one day post-op. There was also a significant decrease in rates of complication as well as direct costs, when anesthesiologists led and participated in a hospitalist service. The study thus concluded that there were patient safety, clinical efficacy, and global cost benefits to the formal inclusion of anesthesiologists as part of the hospitalist care team. Following this study, other medical centers have concurred that anesthesiologists form a vital component of the post-operative period and are qualified to serve in a leadership role.
Progressive methods of delivering care will continue to explore how anesthesiologists can contribute to the perioperative cycle, in and out of the operating room. Post-operative care is essential to ensuring patient safety as well as the patient’s recovery to a healthy, full 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