Expanding the role of the Anesthesiologist to include Hospitalist

March 25, 2019

An article in Anesthesiology News discusses a pilot project at the Loma Linda University Medical Center in California. The Departments of Anesthesiology and Urology teamed-up to establish a perioperative program using anesthesiologists, who are known to be experts in all aspects of the perioperative process, as hospitalists for major urological procedures between 2015 and 2017.

The project produced many positive results including a reduction in recovery time and length of stay for patients and decreased costs. Specific length of stay analyses revealed that LOS fell from a mean of 2.0 days to 1.0 day after prostatectomy (P=0.009), from 4.0 to 3.0 days after nephrectomy (P<0.001), and from 9.0 to 7.0 days after cystectomy (P=0.009).  Of note, the service – which was launched as part of a quality improvement initiative –  was covered by a selected group of anesthesiologists who had received training on the core competencies for hospitalist medicine. While the success of the program has resulted in Loma Linda attempting expansion to other service lines, the article concludes by asking whether anesthesiologists nationwide will seek the additional responsibilities which come along with an expanded perioperative role.

EHCNote: Incorporating anesthesiologists into the perioperative process as hospitalists is an interesting idea with positive results from this and other studies. Fulfilling this role could result in an increase in demonstrable value to hospitals and can serve as a positive point during contract renegotiations or RFPs discussions.  However, in many institutions across the country anesthesiologists already find themselves juggling daily OR, call coverage, governance, practice management and other responsibilities. In many cases it may be challenging to incorporate an additional “hospitalist-like” responsibility – for which it is unclear the level of reimbursement – without also increasing anesthesia staffing and thus the net anesthesia subsidy requirements.