Internal medicine physician embedded in an orthopedic service in a level 1 hospital: clinical impact

Sagi Shashar, Vera Polischuk, Tai Friesem

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The aim of our study was to evaluate the impact of an internist physician specialized in diabetes, appointed as an in-house physician in the orthopedic wards, on improving clinical outcomes and in particular 30-day mortality. Methods: We analyzed a cohort of patients hospitalized more than 24 h in the orthopedic service. The analyses included a comparative analysis between the pre- and post-intervention time periods and an interrupted time series (ITS) analysis, which were conducted in stratification to three populations: whole population, patients with at least one chronic disease and/or older than 75 years of age and patients diagnosed with diabetes. The primary outcome was 30-day mortality following the hospitalization. Results: A total of 11,546 patients were included in the study, of which 19% (2212) were hospitalized in the post intervention period. Although in the comparative analysis there was no significant change in 30-day mortality, in the ITS there was a decrease in the mortality trend during the post intervention period in the entire and chronic disease/elderly populations, compared to no change during the pre-intervention period: a post-intervention slope of − 0.14(p value < 0.001) and − 0.11(p value = 0.03), respectively. Additionally, we found decrease in length of stay, increase in transfers to the internal medicine department with a negative trend, increase in HbA1c testing during the hospitalization and changes in diabetes drugs administration. Conclusion: The presence of an internist in the orthopedic wards is associated with health care improvement; decrease in the 30-day mortality trend, decrease in length of stay, increase in HbA1c testing during the hospitalization and an increase in diabetes drugs administration.

Original languageEnglish
Pages (from-to)339-348
Number of pages10
JournalInternal and Emergency Medicine
Volume17
Issue number2
DOIs
StatePublished - 1 Mar 2022
Externally publishedYes

Keywords

  • 30-day mortality
  • Diabetes
  • Elderly patients
  • Internal medicine physician
  • Orthopedic department

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

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