Surgical Comanagement - UpToDate

1/23/23, 11:07 AM Surgical comanagement - UpToDate
Official reprint from UpToDate®

www.uptodate.com © 2023 UpToDate, Inc. and/or its affiliates. All Rights Reserved.
Surgical comanagement
Authors: Hugo Quinny Cheng, MD, Kevin J Bozic, MD, MBA
Section Editors: Andrew D Auerbach, MD, MPH, Amalia Cochran, MD, FACS, FCCM
Deputy Editors: Jane Givens, MD, MSCE, Kathryn A Collins, MD, PhD, FACS
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Dec 2022. | This topic last updated: Feb 26, 2021.
INTRODUCTION
Comanagement is a model that allows the generalist, frequently a hospitalist, to share the responsibility, authority, and
accountability for the medical care of surgical patients.
This topic will provide an overview of the principles and evidence regarding surgical comanagement. The principles of
traditional medical consultation are discussed elsewhere. (See "Overview of the principles of medical consultation and
perioperative medicine".)
EXPANSION OF THE COMANAGEMENT MODEL
The popularity of comanagement has expanded in parallel with the hospitalist movement. Between 2001 and 2006, the
comanagement of surgical patients by hospitalists increased by over 11 percent per year [1]. The rising prevalence of surgical
comanagement is due to several factors, including an increasing number of patients with advanced age or serious medical
disease undergoing surgery [2,3]. In a cohort of patients undergoing total hip replacement or colectomy between 2007 and
2010, half of the patients were followed by a general medicine consultant [4]. A cross-sectional analysis of 11 United States
https://www.uptodate.com/contents/surgical-comanagement/print 1/16
academic medical centers found that requests for surgical comanagement by orthopedic and neurosurgery departments
comprised the most common reasons for general medicine consultations [5].
GENERAL PRINCIPLES
Medical comanagement of surgical patients can take a variety of forms. Often, the surgeon remains the attending of record,
while the comanaging physician is given wide latitude to manage the nonsurgical aspects of perioperative care. Alternatively,
the surgical patient is admitted to the comanaging physician, who assumes primary responsibility for care but with the surgeon
primarily responsible for managing issues related to perioperative surgical issues including surgical complications. Regardless
of the specific arrangement, comanagement has features that distinguish it from traditional medical consultation ( table 1).
Negotiated relationship — In traditional medical consultation, the role of the consultant is either defined at the time the
consultation is requested or based upon presumed mutual understanding [6]. Comanagement relationships are far more
formal [7]. Protocols and expectations are negotiated between the primary and comanaging physician and often delineated in a
written comanagement agreement prior to initiating patient care. More complex comanagement agreements may be
multidisciplinary, involving nursing, physical therapy, social work, and/or occupational therapy team members. Other potential
partners, such as hospital administrators, may be factored into the agreements as well.
Selection of patients and reasons for referral — With traditional consultation, the surgeon retains sole authority and
responsibility for identifying patients who would benefit from consultant evaluation. The surgeon also determines the latitude
of the consultant's involvement. Consultation etiquette constrains the ability of the consultant to address issues beyond those
specified by the referring provider [6,8]. (See "Overview of the principles of medical consultation and perioperative medicine",
section on 'Performing the consultation'.)
Comanagement relationships usually give the comanaging physician greater leeway in selecting patients and determining
which problems to address. Many comanagement agreements identify clinical criteria that automatically prompt the
comanaging physician's involvement without requiring a formal consult request from the surgeon. The comanagement
agreement may also describe areas of perioperative care that will be the responsibility of the comanaging physician, who is
then free to address any issues within those domains.
Patient selection criteria for comanagement should ideally identify patients at higher risk for perioperative medical
complications; commonly used criteria may include diagnoses (eg, hip fracture), demographic features (eg, advanced age), or
medical comorbidity (eg, dysfunction of specific organ systems). Despite general adherence to this principle, patient selection
methods vary between comanagement programs [9]. The development of a patient selection algorithm that balances value
added and resource stewardship is a focus of ongoing research [10,11].
Broad scope of practice — In contrast to traditional medical consultation services, comanagement relationships provide the
comanaging physician with a broad scope of practice, allowing them to write almost any order, call in additional consultants,
and otherwise manage patients as they deem necessary. The comanagement agreement may, however, indicate some
restrictions on this scope of practice. For example, the comanaging physician might not be permitted to order antiplatelet
agents or anticoagulants without the surgeon's approval, due to the risk of surgical site hemorrhage.
Communication — Also in contrast to traditional medical consultation, lines of communication are much more open and fluid
with comanagement. Whereas all communication with the patient and other providers is routed through the referring surgeon
with traditional consultation [6], the comanaging physician is generally free to communicate directly with the patient and can
expect to be contacted by any care provider who has concerns about the patient. (See "Overview of the principles of medical
consultation and perioperative medicine", section on 'Review with the patient'.)
BENEFITS
Despite its growing popularity, comanagement has not been proven to universally improve clinical outcomes, although it may
be associated with improved provider satisfaction and efficiency of care.
Clinical outcomes — Although it seems reasonable to expect that patients at higher risk for complications will derive greater
benefit from medical comanagement, the clinical outcomes of comanagement are mixed:
● In a randomized trial, over 500 adult patients with medical comorbidities undergoing elective hip or knee arthroplasty
were assigned to traditional medicine consultation service or a hospitalist-led comanagement service [12]. Comanaged
patients were more likely to be discharged without a complication (62 versus 50 percent). The difference was driven by a
reduction in minor complications, such as electrolyte abnormality, fever, or urinary tract infection. There was no difference
in the incidence of more serious complications, such as myocardial infarction, pulmonary embolism, or pneumonia.
● In a 2020 meta-analysis including 14 prospective studies of surgical patients, comanagement was not associated with a
reduction in mortality [9]. There was wide variability among the individual studies included, such as the structure of their
comanagement services (eg, multidisciplinary team collaboration, internist versus hospitalist involvement), the nature of
patient selection, and elective versus emergency surgical procedures. In a subgroup analysis, only comanagement with
involvement of a multidisciplinary care team was associated with a reduction in mortality (odds ratio [OR] 0.67, 95% CI
0.51-0.88).
● In a meta-analysis including 4 studies (two randomized trials and two nonrandomized controlled trials) and almost 1000
adult noncardiac surgery patients, postoperative comanagement did not reduce in-hospital mortality [13].
● In a prospective study, over 200 older adults with acute hip fracture were assigned to orthogeriatric comanagement or to
an orthopedic team with the support of a geriatric consultant service. A group of patients managed with usual orthopedic
care was used as a historical control group. Those in the orthogeriatric comanagement group, but not the geriatric consult
group, had a lower one-year mortality rate (OR 0.31, 95% CI 0.10-0.96) [14].
Although a number of additional observational studies reported that comanagement improves patient outcomes, including
decreasing mortality, complications, and patient-reported pain scores [15-22], several observational studies involving
orthopedic and neurosurgical patients [23-26] found that comanagement is not associated with improved patient outcomes. In
fact, in a retrospective cohort analysis from the American College of Surgeons (ACS) National Surgical Quality Improvement
Program (NSQIP) including approximately 20,000 hip fracture patients, comanagement was associated with increased mortality,
even after adjusting for differences in age and comorbidities (OR 1.36, 95% CI 1.02-1.81) [26].
Satisfaction
● Provider – Surgeons and nurses are consistently more satisfied with comanagement than traditional medical consultation.
In one trial, 90 percent of surgeons and nurses felt that comanagement improved care of orthopedic surgery patients [12].
Similarly, over 90 percent of surgeons and nurses caring for neurosurgical patients felt that hospitalist comanagement
improved patient care and made it easier for them to provide care [25]. This study also found a marked increase in the
perception that unstable patients were promptly identified and treated, medical problems were addressed after discharge,
and there was optimal communication.
● Patient – Several studies of comanagement have not found any meaningful impact on patient satisfaction [12,15,25].
However, one study of joint replacement patients found that after implementation of comanagement with a hospitalist,
patient satisfaction scores improved in three of eight measures [27].
Efficiency of care — Comanagement by hospitalists tends to improve efficiency of care, as measured by length of hospital stay
and hospital costs [15-19,23,25,27].
In observational studies of hip fracture patients, comanagement was associated with decreased time between admission and
surgery and shorter length of stay [14,17,23]. However, in a meta-analysis including prospective studies across several surgical
specialties, there length of stay was similar with and without surgical comanagement [9]. Among the four studies that included
a multidisciplinary team, comanagement was associated with a two-day reduction in length of stay (95% CI, -4.05 to -0.01 days).
A 2020 review of eight surgical comanagement studies including orthopedic, neurosurgical, vascular, and general surgery
patients found an average savings of USD $4132 per patient [28]. However, varied results on overall hospital costs were noted,
and three of the eight studies reported a cost increase. In the studies reporting cost savings, cost reduction did not reduce care
quality, as measured either by mortality, complication rates, or readmission.
RISKS
Shared responsibility can lead to fragmented care and disengagement of the surgeon from direct perioperative care. A poorly
negotiated agreement that devalues the comanaging physician's role can also lead to career dissatisfaction [3].
Fragmented care — Comanagement entails dividing care responsibilities between two providers. While some tasks (such as
wound care) are obviously the purview of the surgeon, and others (such as management of electrolyte derangements) will fall to
the comanaging physician, there are large areas of potential overlap. Without coordination of efforts, tasks can be omitted or
duplicated. For example, a surgeon and comanaging physician may both fail to order a red blood cell transfusion for a severely
anemic patient, as each assumed it was the other provider's responsibility. Furthermore, the actions of one provider may
conflict with that of their counterpart, such as when a hospitalist orders insulin, unaware that the surgeon has restricted the
patient’s oral intake.
Fragmented care also complicates the lines of communication. Nurses or other providers caring for comanaged patients may be
uncertain as to whether to contact the surgeon or comanaging physician with questions or concerns. As a result, important
information can be delayed or omitted. Patients may also be confused by the comanagement arrangement and have difficulty
directing their questions appropriately.
Disengagement of the surgeon — Although the presence of a comanaging physician frees up the surgeon to spend more time
in the operating room or clinic, this can have the unintended consequence of disengaging the surgeon from responsibilities of
managing the perioperative medical care of their patients [3]. This disengagement can leave the comanaging physician to care
for problems beyond their training and experience.
Provider dissatisfaction — While studies have found that surgeons prefer medical comanagement to consultation, less is
known about the comanaging physician satisfaction with this model. Career satisfaction will suffer if much of the work assigned
to the comanaging physician is noncognitive or mundane. Comanaging stable, low-risk patients may also be perceived as
unrewarding. Comanagement can lead to an unequal relationship, typically with the comanaging physician as the more
burdened partner. This may be exacerbated by arrangements that place the comanaging physician under the supervision of the
surgeon. Excessive workloads may also impair satisfaction with comanagement.
KEYS TO SUCCESS
Comanagement is far more complicated than traditional medical consultation and requires considerable advanced planning.
The Society for Hospital Medicine (SHM) has developed a guide for building a comanagement program. While actual
implementation of comanagement will vary according to the needs and capabilities of the hospital medicine group and surgical
service at each hospital, the SHM guide lists six basic steps to forging a successful comanagement service:
● Identify obstacles and challenges
● Clarify roles and responsibilities

● Identify champions
● Address financial issues
● Measure performance
● Establish quality improvement initiatives
Identify obstacles and challenges — Before embarking on comanagement, consideration should be given to potential
obstacles, challenges, and risks to the service. When contemplating the creation of a comanagement relationship, planners
should ask:
● Who are the key stakeholders (eg, surgeons, comanaging physician/hospitalists, hospital administrators, other specialists,
nonphysician providers)?
● What are the goals of comanagement?
● What are the risk to patients and providers if the service is unsuccessful?
● Are there unrealistic assumptions about the effects of comanagement?
Clarify roles and responsibilities — Given the complexity of comanagement arrangements, the specific roles and
responsibilities of the surgeons and comanaging physician must be delineated in a written comanagement agreement. This
helps to prevent errors that can arise from fragmented care and to ensure ongoing provider engagement throughout the
hospital course. Common questions to address are:
● How will patients be selected for comanagement?
● Who will be the attending of record for comanaged patients?
● Which problems and complications will the comanaging physician address versus the surgeon?
● What is the role of each party in patient admission and discharge planning?
● What restrictions will be placed on the comanaging physician's scope of practice?
● What are the protocols for communication, eg, how should nursing (and other ancillary service) calls be directed? When is
direct communication between the surgeon and comanaging physician required? How will management disagreements be
resolved?
Identify champions — Both the surgical and medical groups involved in comanagement should identify individuals with strong
leadership and interpersonal skills who are committed to the success of the service. The champions will represent their groups
when negotiating the comanagement agreement but should also be willing to compromise and act as voice of moderation.
Champions should expect to help resolve conflicts. They should meet regularly after implementation to evaluate and improve
the service, modifying the comanagement agreement as needed.
Comanagement works best when surgical and medical providers are equal stakeholders. The champions must advocate for the
service to their colleagues, as well as to the hospital, which may be asked to provide financial or logistical support. The
champions must understand the needs and capabilities of their groups. For instance, the surgical group champion should
recognize what problems are beyond the surgeons' capabilities to manage, and the comanaging medicine group champion
should know how many patients a comanaging physician can comanage at once.
Address financial issues — The vast majority of hospital medicine programs cannot meet their financial obligations without
support, which typically comes from the hospital [29]. Before agreeing to create a comanagement service, stakeholders should
estimate the revenue that the combined medical-surgical comanagement service will generate and agree on how any deficit will
be funded.
Measure performance — In addition to tracking census data and case mix, the service champions should determine if
comanagement has improved clinical outcomes, satisfaction, and efficiency of care.
● Clinical outcomes – Commonly measured clinical outcomes include:
• Mortality rates.
• Surgical and medical complications.
• Unplanned transfers to an intensive care unit.
• 30-day readmission rates.
• Process outcomes that reflect quality of care. These may include a combination of condition-specific patient-reported
outcomes, laboratory findings, and/or standardized, clinical examination metrics. The specific process outcomes
selected should be those commonly used to assess the condition of interest to facilitate comparisons across different
comanagement programs. As an example, for in-hospital geriatric comanagement programs, a 2018 expert consensus
identified the following as the most relevant quality indicators: cognition/delirium, functionality/mobility, falls, pain,
medication and pressure ulcers [30]. (See "Measuring quality in hospitals in the United States", section on 'Reported
measures of hospital quality'.)
● Satisfaction – Satisfaction with comanagement should be assessed in patients, surgeons, hospitalists, nurses and other
stakeholders. Patient satisfaction is usually evaluated using standard survey, such as those developed by Press Ganey or
the Hospital Consumer Assessment of Healthcare Providers and Systems [31]. Providers can be surveyed on satisfaction
with issues such as:
• Quality and promptness of communication

• Availability of the surgeon or hospitalist to address complications
• Quality of discharge planning
• Impact of comanagement on the provider's ability to deliver care
• Overall quality of medical care
● Efficiency – Efficiency of care is of particular concern to the hospital. Typical measurements include:
• Overall length of stay, as well as time from admission to surgery and from surgery to discharge
• Direct hospital costs per admission
• Surgery cancellation rates
Establish quality improvement initiatives — The complex and dynamic nature of comanagement programs requires
continuous and intentional quality improvement efforts. The most effective quality improvement efforts are those that are
intentional, structured, and iterative, such as the “Plan-Do-Study-Act” (PDSA) or the Deming cycle [32].
Quality-improvement teams, led by program champions, should meet regularly to review internal performance measures,
evaluate the applicability of all available evidence, and identify areas of improvement. In addition, for comanagement programs
that include multidisciplinary teams, representatives from each discipline should have a voice in this process.
Such initiatives have been demonstrated to improve quality measures. As examples, two studies on the longitudinal
performance of surgical comanagement programs found improvement in program quality measures over a five-year period
starting at program conception [33,34].
SUMMARY AND RECOMMENDATIONS
● Comanagement is a model that allows the generalist, frequently a hospitalist, to share the responsibility, authority, and
accountability for the medical care of surgical patients. (See 'Introduction' above.)
● Compared with traditional medical consultants, comanaging physicians provide care under protocols established in a
negotiated agreement with the surgeons ( table 1). Often, the surgeon remains the attending of record, while the
comanaging physician is given wide latitude to manage the nonsurgical aspects of perioperative care. Alternatively, these
roles may be reversed, and the surgical patient is admitted to the comanaging physician, who assumes primary
responsibility for care. (See 'Negotiated relationship' above and 'General principles' above.)
● Despite its growing popularity, comanagement has not been proven to universally improve clinical outcomes, although it
may be associated with improved provider satisfaction and efficiency of care. The involvement of a multidisciplinary team
may improve clinical outcomes. (See 'Benefits' above.)
● Potential risks associated with comanagement include fragmentation of care, disengagement of the surgeon,
dissatisfaction of the comanaging physician, and patient confusion. (See 'Risks' above.)
● Creation of a successful comanagement program requires identification of potential obstacles to implementation,

clarification of roles and responsibilities of each provider in the relationship, identification of strong champions committed
to the program’s success, performance measurements, and the establishment of continuous quality improvement
initiatives. (See 'Keys to success' above.)
ACKNOWLEDGMENT
The UpToDate editorial staff acknowledges Vincent Galea, who contributed to the most recent revision of this topic.
Use of UpToDate is subject to the Terms of Use.
REFERENCES
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3. Siegal EM. Just because you can, doesn't mean that you should: A call for the rational application of hospitalist
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4. Chen LM, Wilk AS, Thumma JR, et al. Use of medical consultants for hospitalized surgical patients: an observational cohort
study. JAMA Intern Med 2014; 174:1470.
5. Wang ES, Moreland C, Shoffeitt M, Leykum LK. Who Consults Us and Why? An Evaluation of Medicine
Consult/Comanagement Services at Academic Medical Centers. J Hosp Med 2018; 13:840.
6. Goldman L, Lee T, Rudd P. Ten commandments for effective consultations. Arch Intern Med 1983; 143:1753.
7. Mendelson DA, Friedman SM. Principles of comanagement and the geriatric fracture center. Clin Geriatr Med 2014; 30:183.
8. Salerno SM, Hurst FP, Halvorson S, Mercado DL. Principles of effective consultation: an update for the 21st-century
consultant. Arch Intern Med 2007; 167:271.
9. Shaw M, Pelecanos AM, Mudge AM. Evaluation of Internal Medicine Physician or Multidisciplinary Team Comanagement of
Surgical Patients and Clinical Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e204088.
10. Horta AB, Salgado C, Fernandes M, et al. Clinical decision support tool for Co-management signalling. Int J Med Inform
2018; 113:56.
11. Montero Ruiz E, Rubal Bran D, por el Grupo de Trabajo de Asistencia Compartida e Interconsultas de la Sociedad Española
de Medicina Interna. Which surgical patients require shared care? Rev Clin Esp 2020.
12. Huddleston JM, Long KH, Naessens JM, et al. Medical and surgical comanagement after elective hip and knee arthroplasty:
a randomized, controlled trial. Ann Intern Med 2004; 141:28.
13. Mazzarello S, McIsaac DI, Montroy J, et al. Postoperative shared-care for patients undergoing non-cardiac surgery: a
systematic review and meta-analysis. Can J Anaesth 2019; 66:1095.
14. Baroni M, Serra R, Boccardi V, et al. The orthogeriatric comanagement improves clinical outcomes of hip fracture in older
adults. Osteoporos Int 2019; 30:907.
15. Rohatgi N, Loftus P, Grujic O, et al. Surgical Comanagement by Hospitalists Improves Patient Outcomes: A Propensity Score
Analysis. Ann Surg 2016; 264:275.
16. Tadros RO, Faries PL, Malik R, et al. The effect of a hospitalist comanagement service on vascular surgery inpatients. J Vasc
Surg 2015; 61:1550.
17. Della Rocca GJ, Moylan KC, Crist BD, et al. Comanagement of geriatric patients with hip fractures: a retrospective,
controlled, cohort study. Geriatr Orthop Surg Rehabil 2013; 4:10.
18. Kammerlander C, Roth T, Friedman SM, et al. Ortho-geriatric service--a literature review comparing different models.
Osteoporos Int 2010; 21:S637.
19. Hinami K, Feinglass J, Ferranti DE, Williams MV. Potential role of comanagement in "rescue" of surgical patients. Am J Manag
Care 2011; 17:e333.
20. Montero Ruiz E, Rebollar Merino Á, Rivera Rodríguez T, et al. Effect of comanagement with internal medicine on hospital
stay of patients admitted to the Service of Otolaryngology. Acta Otorrinolaringol Esp 2015; 66:264.
21. Iberti CT, Briones A, Gabriel E, Dunn AS. Hospitalist-vascular surgery comanagement: effects on complications and
mortality. Hosp Pract (1995) 2016; 44:233.
22. Png CY, Faries PL, Qian LY, et al. Vascular surgery pain outcomes improved by implementing hospitalist comanagement
service. Pain Manag Med 2016; 2:2.
23. Phy MP, Vanness DJ, Melton LJ 3rd, et al. Effects of a hospitalist model on elderly patients with hip fracture. Arch Intern Med
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24. Batsis JA, Phy MP, Melton LJ 3rd, et al. Effects of a hospitalist care model on mortality of elderly patients with hip fractures. J
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25. Auerbach AD, Wachter RM, Cheng HQ, et al. Comanagement of surgical patients between neurosurgeons and hospitalists.
Arch Intern Med 2010; 170:2004.
26. Maxwell BG, Mirza A. Medical Comanagement of Hip Fracture Patients Is Not Associated with Superior Perioperative
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27. Fitzgerald SJ, Palmer TC, Kraay MJ. Improved perioperative care of elective joint replacement patients: the impact of an
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28. Luu BC, Davis MJ, Raj S, et al. Cost-effectiveness of surgical comanagement: A systematic review. Surgeon 2021; 19:119.
29. Wachter RM, Goldman L. The hospitalist movement 5 years later. JAMA 2002; 287:487.
30. Van Grootven B, McNicoll L, Mendelson DA, et al. Quality indicators for in-hospital geriatric co-management programmes: a
systematic literature review and international Delphi study. BMJ Open 2018; 8:e020617.
31. Center for Medicare and Medicaid Services. Hospital CAHPS. 2009. Available at: http://www.hcahpsonline.org/home.aspx (A
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32. Tague NR. The Quality Toolbox, 2nd, American Society for Quality, 2013.
33. Roll C, Tittel S, Schäfer M, et al. Continuous improvement process: ortho-geriatric co-management of proximal femoral
fractures. Arch Orthop Trauma Surg 2019; 139:347.
34. Rohatgi N, Weng Y, Ahuja N. Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years. J Hosp Med
2020; 15:232.
Topic 16284 Version 17.0
GRAPHICS
Differences between traditional medical consultation and comanagement
Traditional medical consultation Comanagement
Relationship between comanaging Ad hoc, informal Formal, previously negotiated

physician and surgeon
Patient selection process Only through referral by surgeon Predetermined selection criteria
Comanaging physician's focus Confined to issues identified by surgeon Comanaging physician's discretion or based
on previously negotiated agreement
Comanaging physician's scope of practice Makes recommendations; limited order Broad scope of practice; can write most
writing privileges orders
Communication protocols All communication routed through surgeon Comanaging physician may directly
communicate with patient and other
providers
Courtesy of Hugo Cheng, MD and Kevin Bozic, MD, MBA.
Graphic 107524 Version 2.0
Contributor Disclosures
Hugo Quinny Cheng, MD No relevant financial relationship(s) with ineligible companies to disclose. Kevin J Bozic, MD, MBA Equity
Ownership/Stock Options: Carrum Health [Bundled payments in orthopedic surgery]. Grant/Research/Clinical Trial Support: Agency for
Healthcare Research and Quality [Value-based payment models]. Consultant/Advisory Boards: Purchaser Business Group on Health
[Evaluation of musculoskeletal digital health offerings];Yale Center for Outcomes Research and Evaluation [Value-based payment models].
Other Financial Interest: American Academy of Orthopaedic Surgeons[Vice president];OM1 [codeveloping shared decision making tool]. All of
the relevant financial relationships listed have been mitigated. Andrew D Auerbach, MD, MPH No relevant financial relationship(s) with
ineligible companies to disclose. Amalia Cochran, MD, FACS, FCCM Other Financial Interest: JAMA Surgery [Web and social media editor]. All
of the relevant financial relationships listed have been mitigated. Jane Givens, MD, MSCE No relevant financial relationship(s) with ineligible
companies to disclose. Kathryn A Collins, MD, PhD, FACS No relevant financial relationship(s) with ineligible companies to disclose.
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a
multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content
is required of all authors and must conform to UpToDate standards of evidence.
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1/23/23, 11:07 AM Surgical comanagement - UpToDate

Official reprint from UpToDate®

EXPANSION OF THE COMANAGEMENT MODEL

● Identify obstacles and challenges

● Clarify roles and responsibilities

● What are the goals of comanagement?

● Are there unrealistic assumptions about the effects of comanagement?

● How will patients be selected for comanagement?

● Who will be the attending of record for comanaged patients?

● What restrictions will be placed on the comanaging physician's scope of practice?

● Clinical outcomes – Commonly measured clinical outcomes include:

• Surgical and medical complications.

• Unplanned transfers to an intensive care unit.

• 30-day readmission rates.

• Quality and promptness of communication

SUMMARY AND RECOMMENDATIONS

● Creation of a successful comanagement program requires identification of potential obstacles to implementation,

Use of UpToDate is subject to the Terms of Use.

Topic 16284 Version 17.0

Differences between traditional medical consultation and comanagement

Traditional medical consultation Comanagement

Relationship between comanaging Ad hoc, informal Formal, previously negotiated

Courtesy of Hugo Cheng, MD and Kevin Bozic, MD, MBA.

Graphic 107524 Version 2.0

Conflict of interest policy

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