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Vol. 66. Issue 5.
Pages 264-268 (September - October 2015)
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Vol. 66. Issue 5.
Pages 264-268 (September - October 2015)
Original article
Effect of Comanagement With Internal Medicine on Hospital Stay of Patients Admitted to the Service of Otolaryngology
Efecto de la asistencia compartida con medicina interna sobre la estancia hospitalaria de los pacientes ingresados en el Servicio de Otorrinolaringología
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Eduardo Montero Ruiza,
Corresponding author
, Ángela Rebollar Merinoa, Teresa Rivera Rodríguezb, Marta García Sáncheza, Rosa Agudo Alonsoa, José Maria Barbero Allendea
a Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
b Servicio de Otorrinolaringología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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Table 1. Results.
Abstract
Introduction and objectives

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

Methods

This was a retrospective observational study including patients ≥14 years old discharged from ENT between 1/1/2009 and 30/06/2013, with co-management from May/2011. We analysed age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of discharge diagnoses, Charlson comorbidity index (CCI), deaths, readmissions and LoS.

Results

There were statistically significant differences between both groups in age (4.5 years; 95% confidence interval [95% CI] 2.8–6.3), emergency admissions (odds ratio [OR] 1.4; 95% CI 1.1–1.8), administrative weight (0.3637; 95% CI 0.0710–0.6564), number of diagnoses (1.3; 95% CI 1–1.6), CCI (0.4; 95% CI 0.2–0.6) and deaths (OR 4.1; 95% CI 1.1–15.7). On adjustment, co-management reduced ENT LoS in hospital by 28.6%, 0.8 days (95% CI 0.1%–1.6%; P=.038). This reduction represents an ENT savings of at least €165893.

Conclusions

Co-management patients admitted to ENT are increasing in age, comorbidity and complexity. Co-management is associated with reduced LoS and costs in ENT, similar to those observed in other surgical services.

Keywords:
Referral and consultation
Co-management
Otolaryngology
Internal medicine
Resumen
Introducción y objetivos

Los pacientes ingresados en el Servicio de Otorrinolaringología (ORL) están aumentando en 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 ORL.

Métodos

Estudio observacional retrospectivo de los pacientes ≥ 14 años ingresados desde el 1 de enero del 2009 hasta el 30 de junio del 2013 en ORL; desde mayo del 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), defunción, reingresos y estancia hospitalaria.

Resultados

Los pacientes con AC fueron de mayor edad (4,5 años, intervalo de confianza del 95% [IC del 95%], 2,8 a 6,3), con más ingresos urgentes (odds ratio [OR] 1,4; IC del 95%, 1,1 a 1,8), mayor peso administrativo (0,3637; IC del 95%, 0,0710 a 0,6564), mayor número de diagnósticos (1,3; IC del 95%, 1 a 1,6), ICh (0,4; IC del 95%, 0,2 a 0,6) y también de defunción (OR 4,1; IC del 95%, 1,1 a 15,7). Al ajustar, observamos que la AC redujo el 28,6% la estancia en ORL, 0,8 días (IC del 95%, 0,1 a 1,6; P=0,038). Este descenso supone un ahorro, al menos, de 165.893 €.

Conclusiones

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

Palabras clave:
Remisión y consulta
Asistencia compartida
Otorrinolaringología
Medicina Interna

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