Published in the January 2011 issue of Today's Hospitalist
We begin the new year by taking a new look at a familiar topic: the pros and cons of comanagement.
There seems to be no end in sight to the specialties begging for help from hospitalists. And now, some specialties are trying to kick comanagement up to actual admissions. A good example is in our cover story, which and focuses on a request that most hospitalists five years ago would have argued was outrageous: admitting pregnant patients to the hospitalist service.
The obvious problem is that most hospitalists have little to no training in caring for pregnant patients. But that’s not stopping some hospitalists from taking baby steps and venturing into pregnant-patient admissions. Hospitalists can manage the risks of moving beyond comanagement, the thinking goes, as long as they work closely with specialists.
But that’s only if all the comanagement details get hammered out, as we point out in a case study of a neurosurgical comanagement arrangement that went seriously wrong. This real-life case is a classic example of how misunderstanding and miscommunication in comanagement can be disastrous for patients—and make hospitalists legally vulnerable.
Finally, a new study that we cover briefly echoes what some of you have been saying for years: Comanagement arrangements don’t always improve patient care.
Data from the University of California, San Francisco conclude that having hospitalists comanage neurosurgery patients does little to improve care or outcomes. The main benefit, researchers concluded, was that hospitalists saved about $1,400 per case.
Comanagement may save your hospital money and make the lives of surgeons easier, but at what cost to you as a hospitalist? Or is it unfair to compare the comanagement of neurosurgery patients to, say, orthopedic or GI patients? Those are interesting questions to ask as you calculate the risk-benefit equation of comanagement—and, now, admission—agreements.
