How to Know Which Patients to 'Watch Like a Hawk'
Major Finding: Overall mortality was 1% using a preoperative risk stratification model compared with 1.4% in a comparator hospital.
Data Source: Pilot study comparing a cohort of surgical patients stratified through the PRiSM model to surgery patients at another hospital that had the same number of surgeons.
Disclosures: Dr. Ravikumar is CEO of PRiSM Integrated Health Strategies, which owns the PRiSM concept.
FROM A MEETING ON PERIOPERATIVE MEDICINE SPONSORED BY THE UNIVERISTY OF MIAMI
Dr. Ravikumar outlined how a typical day works using the PRiSM strategy. At 7:30 a.m., hospitalist handoff occurs. Pre-rounding on the patient floor, during which time the hospitalist consults with the surgeons, continues until 9 a.m. An agreement to comanage patients with surgery is an essential component, Dr. Ravikumar said.
From 9-10 a.m., simultaneous continuum of care rounds are performed by the multidisciplinary team: hospitalists, surgical team, nurses, care managers, pharmacists, and residents. "Everyone sits in and finishes seeing all those patients in 1 hour, mostly ... for discharge planning in the hospital," Dr. Ravikumar said. From 10-10:30 a.m., the hospitalist and continuum of care physician do the "hawk huddle" to confer on the list of patients who will require more scrutiny.
The use of a rounding tool (either mobile or based in the electronic medical record system) is required to make this multidisciplinary assessment effective, Dr. Ravikumar said. The tool needs to be easily accessible during rounds and easily navigated for each patient by the providers, nurses, occupational therapists, physical therapists, and pharmacists.
Although the hawk criteria are currently descriptive, "we have developed a model composite score based on preoperative variables, intraoperative happenings, and postoperatively, things that happen in the first 2 hours," Dr. Ravikumar said. Decision support based on the score is essential, he added, "so you know what to do in the next hour for this individual patient."
Dr. Ravikumar said that he had no relevant financial disclosures. Dr. Michota is the medical editor of Hospitalist News, an Elsevier publication.
