P4A165: Shareing Is Caring: The Development of a Surgical Co-management Program at Children’s Hospital Colorado

Purpose/Objectives: The Society of Hospital Medicine defines surgical co-management as: “The shared responsibility, authority, and accountability for the care of a hospitalized patient...In the case of co-managed surgical patients, the patient’s surgeon manages the surgery related treatments, and the hospitalist manages the patient’s medical conditions". Literature demonstrates that hospital medicine co-management of surgical patients can lead to decreased length of stay, decreased cost, decreased readmissions rates, and overall improved care. Review of a surge in serious patient safety events on Children Hospital Colorado’s (CHCO’s) medical-surgical floor revealed opportunities to improve post-operative care of hospitalized surgical patients. In response, we developed the Surgical Hospitalist Recovery (SHARe) Team. This team aims to: 1) provide individualized, comprehensive, optimal care to every co-managed patient on the service; 2) support medical-surgical nursing staff by providing quick responses, clear communication, and augmented education; and 3) make CHCO the nation’s flagship institution for surgical hospitalist co-management.

Design/Methods: Institutional leadership at CHCO funded 24/7 inpatient hospitalist coverage for SHARe Team. 10.4 clinical FTE was approved to support 2 APPs and 1 MD coverage during the day with MD Nocturnist coverage at night. A comprehensive full day orientation process and hospitalist-surgical provider open house was facilitated for all new SHARe Team providers, along with dissemination of a comprehensive educational handbook. Operational agreements were created with 13 surgical subspecialties. Patients designated for post-operative admission to this service included 1) those with highest medical complexity 2) those with prior operational agreements 3) those with no current inpatient surgical home/providers and 4) ad hoc admissions. Projected census was 22-24 patients per day using these parameters. SHARe was implemented in September 2022. For preliminary evaluation we compared pre and post-SHARe implementation surgical inpatient hospital length of stay and emergent or urgent surgical inpatient transfers to the PICU. Emergent transfers were defined as unplanned ICU transfer plus life-sustaining interventions (endotracheal intubation, vasopressor initiation, or ≥3 parenteral fluid boluses) in the first ICU hour. Urgent transfers were defined as unplanned ICU transfer plus life-sustaining interventions in the first 12 ICU hours.

Results: Preliminary data demonstrates both decreased length of stay and decreased emergent or urgent transfers for ALL patients on the medical-surgical floor at CHCO, not just SHARe Team admissions. SHARe Team currently accounts for approximately 10% of all admitted surgical patients.

Conclusion/Discussion: The SHARe Team at CHCO is a novel co-management service that may improve short-term outcomes amongst surgical patients admitted electively with the highest complexity and comorbidity. We believe the positive outcomes on SHARe Team patients are robust enough to demonstrate benefit for all surgical patients admitted. Further studies are needed to determine whether this team will sustainably reduce length of stay, readmissions and serious safety events. We also plan to evaluate patient, provider and nursing satisfaction.