“Daily medical liaison is associated with reduced length of stay in a
regional vascular surgery service: a before-and-after study.”
Abstract
Objective: To determine the impact of the introduction and establishment
of a daily medical liaison service provided to patients aged 65 years
and older attending a regional vascular surgery centre. Methods and
Analysis: Descriptive before-and-after study concerning 375 patients
(pre-intervention n=171, post-intervention n=204). Retrospective
case-note analysis during two three-month periods (January-March, 2017
and 2018). Intervention comprised daily senior-led medical liaison
review. Primary outcome measure was length of stay (LOS). Results were
analysed using SPSS Statistics 23. Descriptive analyses were performed
in addition to correlation and regression analyses to identify key
predictors of postoperative outcome. Results: There was a trend
reduction in LOS from 10.75 to 7.95 days (p=0.635, 95% CI 0 – 1 day)
with a significant reduction in mean LOS for patients admitted for
longer than seven days (7.84 days, p=0.025, 95% CI for mean difference,
1.5 to 14 days). This group also benefited reduced 30-day readmission
rates (12/60 to 8/72, p=0.156, 95% CI -3% to 21%). Trend reduction in
the number of postoperative complications was seen (1.09 to 0.86 per
person, p=0.181, 95% CI -0.11 to 0.56), which reached statistical
significance in emergency vascular admissions (1.81 to 0.97 per person,
p=0.01, mean difference = 0.84, 95% CI 0.21 – 1.46). Conclusion: This
study has demonstrated reduced LOS and complications associated with
daily medical liaison in selected older patients admitted under vascular
surgery. The greatest benefit appears to be in patients admitted for
more than seven days or in emergency admissions. These data are amongst
the first to reproduce randomised control trial findings in a non-trial
setting. They indicate which patient groups may benefit most from
collaborative models of care where resources are finite.