Hospitalist Medical Consultant / Orthopedic Surgery Co-Management

Agreement

Admitting Service:

  • All patients with a primary orthopedic problem that is clearly or possibly indicated for surgery will be admitted to Orthopedic Surgery, with timely hospitalist consult service response.

  • At time of admission, if orthopedic surgery feels the patient would be better cared for on a medicine service, the hospitalist will be called by the orthopedic provider and a colleague-to-colleague discussion will be had about hospitalist admission. ED physicians, unit clerks, or RNs, will not be asked to call the hospitalist and notify them that orthopedics would like hospitalist to admit.

  • During hospitalization, if medical issues become more active than orthopedic issues, request to transfer can be made by provider-to-provider conversation. If a patient on the orthopedic surgery primary service becomes IMC level of care, they should transfer to the hospital medicine service.

Consult Service:

  • All consults will be called from orthopedic staff, resident, or APP to hospitalist and vice versa via direct communication between providers. If the orthopedic surgeon has reservations or concerns regarding the care and treatment of the patient, they will contact the hospitalist and the hospitalist will intercede and take lead responsibility for the care of the patient.

  • ED physicians, unit clerks, or RNs will not be asked to notify providers of consult request, as consult request should include information regarding nature and urgency of consult.

  • There will be daily communication (verbal, written, or secure chat) between providers caring for a patient.

  • If the consulting service feels they are no longer needed, they will verbally communicate with the primary service if they may sign off, and if mutually agreed upon, a formal note documenting that consultation and co-management has stopped will be written. When hospital medicine has been consulted for an orthopedic patient older than 65 years old with medical comorbidities and/or has a hip fracture, the hospitalist should not sign off before POD1.

Division of Duties/Order Writing:

  • Patients admitted to orthopedic surgery will have their home medications reconciled by the orthopedic surgery service. When hospital medicine is consulted, whether for preoperative evaluation or co-management, it is the responsibility of the hospital medicine provider to review the patient's home medications and ensure they are ordered or held as appropriate. If the hospitalist disagrees with a home medication being ordered or held, they will discuss this with the orthopedic surgery provider. Orthopedic surgery is responsible for ordering DVT prophylaxis when primary. The hospitalist is responsible for ordering labs for medical issues they are managing.

  • When hospital medicine is the primary service with orthopedic surgery consulting, it is the responsibility of the orthopedic surgery provider to place orders for activity, weight bearing, and wound care, and to perform dressing changes. Orthopedic surgery will make recommendations for DVT prophylaxis, but it is the responsibility of hospital medicine to order DVT prophylaxis. Orthopedic surgery will document follow up recommendations (including when the patient should follow up, what imaging is needed, and which provider or clinic the patient should follow up with) in their consult notes when these follow up needs are known.

  • Orthopedic surgery

  • Activity

  • PT orders

  • Anticoagulation

  • Transfusions (hospitalist may be asked to provide recommendations on transfusion threshold)

  • Pain management

  • Wound care

  • Diet

  • Perioperative antibiotics

  • Hospitalist

  • BP management

  • IV fluids

  • Respiratory issues

  • Chest pain

  • Arrhythmias

  • Electrolytes

  • Telemetry

  • Diabetes management

  • Any other medical issues -- UTI, pneumonia, alcohol withdrawal, delirium, etc.

Last updated 12.18.24

Alexandra Wick, MD

Paul Whiting, MD