Ann Thorac Surg 2007;83:107
© 2007 The Society of Thoracic Surgeons
Original Articles: Cardiovascular
Invited commentary
Kevin Accola, MD
Department of Surgery, Cardiovascular Surgeons,PA, 217 Hillcrest Street, Orlando, FL 32801
(Email: annetteg{at}cvsorlando.com).
This article [1] clearly demonstrates again the surgical dogma that healthier patients do better and can typically go home sooner; the very detailed statistical analysis and computation of this retrospective review demonstrates this objectively. Nationally, as every other practice has accepted and incorporated the catch phrase "fast tracking" into their practices to some degree, the reality of this expedited hospital convalescence is that oftentimes more work and resources are dependent on the individual clinical practices. When we initiated "fast track" protocols, patients did indeed leave the hospital earlier, although calls to our office nurses regarding questions about activity, wounds, various symptoms, and so forth increased substantially. In concluding that there is a "hospital savings demonstrated," we believe this needs to be viewed as "cost shifting" from hospitals to individualized practices. This increased workload for the practices’ clinical staff is a nonfunded liability, which is certainly not being considered nor taken into account with practice expense issues. Practice expense continues to be a sore point with most cardiovascular surgical practices, as more and more of the expenses that the hospital "saves" on are actually being shifted to the individual practices.
Another perspective comes from the referring family physicians who now also receive more inquiries regarding medications, arrhythmia problems, and so forth that they were not accustomed to beforehand. Nearly all referring physicians just want their patients returned to them "fixed." Often in the real world practices, it does not take many of these phone calls to alter referral patterns.
We believe this article does have merit (ie, healthier patients do better and can safely go home earlier). However, not to lose perspective of the "big picture" as many of these expeditious discharge protocols in reality merely "cost-shift" responsibility to the private practitioner as an unfunded liability. We conclude that the "big picture" problem remains unfixed until practice expense issues are dealt with in the reimbursement scheme.
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- Cowper PA, DeLong ER, Hannan EL, et al. Is early too early?Effect of shorter stays after bypass surgery. Ann Thorac Surg 2007;83:100-107.[Abstract/Free Full Text]
Related Article
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Is Early Too Early? Effect of Shorter Stays After Bypass Surgery
- Patricia A. Cowper, Elizabeth R. DeLong, Edward L. Hannan, Lawrence H. Muhlbaier, Barbara L. Lytle, Robert H. Jones, William L. Holman, Janel J. Pokorny, Judith A. Stafford, Daniel B. Mark, and Eric D. Peterson
Ann. Thorac. Surg. 2007 83: 100-107.
[Abstract]
[Full Text]
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