Effect of co-management with Internal Medicine on hospital stay in Ophthalmology

Abstract

Objective

Patients admitted to the Department of Ophthalmology (OPH) are of increasing age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. The effect of co-management on length of hospital stay was studied in patients admitted to OPH.

Methods

Retrospective observational study was performed that included patients ≥14 years old discharged from OPH between 1 January 2009 and 30 June 2013, who were co-managed from May 2011. An analysis was made including age, sex, type of admission, whether it was operated on, administrative weight associated with GRD, total number of discharge diagnoses, Charlson comorbidity index (CCI), mortality, readmissions, and LoS.

Results

There were statistically significant differences between the groups in operated patients (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 1.5 to 3.6), administrative weight (0.1160; 95% CI 0.0738 to 0.1583), and number of diagnoses (0.9, 95% CI 0.5 to 1.3). On adjustment, co-management reduced LoS in OPH by 27.8%, 0.5 days (95% CI 0.1 to 1).

Conclusions

Patients admitted to OPH have increasing comorbidity and complexity. Co-management is associated with a reduced LoS and costs in OPH, similar to that observed in other surgical services.

Resumen

Objetivo

Los pacientes ingresados en el Servicio de Oftalmología (OFT) están aumentando su edad, comorbilidad y complejidad, induciendo un incremento de interconsultas a Medicina Interna (MI). Una alternativa a las interconsultas es la asistencia compartida (AC). Estudiamos el efecto de la AC con MI sobre la estancia hospitalaria de los enfermos ingresados en OFT.

Métodos

Estudio observacional retrospectivo de los pacientes ≥ 14 años ingresados desde el 1/1/2009 al 30/06/2013 en OFT; desde mayo de 2011 con AC con MI. Analizamos edad, sexo, tipo de ingreso, si fue operado, peso administrativo asociado a GRD, número total de diagnósticos al alta, índice de comorbilidad de Charlson (ICh), fallecimiento, reingresos y estancia hospitalaria.

Resultados

Entre ambos grupos, hubo diferencias estadísticamente significativas en el porcentaje de pacientes operados (odds ratio [OR] 2,3, intervalo de confianza del 95% [IC 95%]: 1,5 a 3,6), peso administrativo (0,1160; IC 95%: 0,0738 a 0,1583) y número de diagnósticos (0,9; IC 95%: 0,5 a 1,3). Al ajustar, observamos que la AC redujo el 27,8% la estancia en OFT, 0,5 días (IC 95%: 0,1 a 1).

Conclusiones

Los enfermos ingresados en OFT están aumentando su comorbilidad y complejidad. La AC se asocia a una disminución de la estancia y costes en OFT, similares a los observados en otros servicios quirúrgicos.