• Sagi Shashar, Vera Polischuk, and Tai Friesem.
• Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O.Box 151, 84101, Be'er Sheva, Israel. sagishas@post.bgu.ac.il.
• Intern Emerg Med. 2022 Mar 1; 17 (2): 339348339-348.

BackgroundThe 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.MethodsWe 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.ResultsA 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.ConclusionThe 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.© 2021. Società Italiana di Medicina Interna (SIMI).

17 keywords...

hide…