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

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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.

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Author information

Author notes

  1. Sagi Shashar and Vera Polischuk have contributed equally.

Authors and Affiliations

  1. Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O.Box 151, 84101, Be’er Sheva, Israel

    Sagi Shashar

  2. Orthopedic Surgery Service, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Vera Polischuk

  3. Chairmen of Orthopedic Surgery, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Tai Friesem

Authors
  1. Sagi Shashar
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  2. Vera Polischuk
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  3. Tai Friesem
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Contributions

SS: substantial contributions to the design of the work and writing, VP: substantial contributions to the conception of the work and writing, TF: substantively revised the work and approved it.

Corresponding author

Correspondence to Sagi Shashar.

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The authors declare that they have no competing interests

Research involving human and animal participant

The research shows that a diabetes specialized internist embedded in an orthopedic service is associated with health care improvements for the elderly population; decrease in the 30-day mortality trend, decrease in LOS, increase in HbA1c testing during the hospitalization and increase in diabetes drugs administration.

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For this type of study no informed consent is required.

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Shashar, S., Polischuk, V. & Friesem, T. Internal medicine physician embedded in an orthopedic service in a level 1 hospital: clinical impact. Intern Emerg Med 17, 339–348 (2022). https://doi.org/10.1007/s11739-021-02745-5

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  • DOI: https://doi.org/10.1007/s11739-021-02745-5

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