OR Opportunity

In this era of increasing synergy between the surgical and hospital medicine services, Minnesota hospitalist David Frenz, MD, has taken perioperative management of surgical patients a step further.

One or two days a week, Dr. Frenz can be found in the operating room (OR) of St. Joseph’s Hospital in St. Paul, assisting on multilevel spine surgery cases.

Although Dr. Frenz may be a one-of-a-kind hospitalist acting as first assistant in the OR, the approach offers many advantages to his hospital and hospital medicine service, says Robert C. Moravec, MD.

“It seems more efficient having one assistant surgeon [rather than several scrub technicians] who knows exactly what’s going to happen next,” says Dr. Moravec, medical director for both the hospital service and St. Joseph’s Hospital. “More importantly, it’s a way to develop some expertise in the perioperative arena and to develop collaborative relationships with the surgeons.” In addition, the hospital service is able to bill for an assistant surgeon’s fee, which covers much of Dr. Frenz’ salary. And when he’s not on the medical floors seeing patients, Dr. Frenz is engaged in a monthslong quality improvement (QI) project to improve perioperative care and reduce same-day surgery cancellations at his institution.

The effectiveness of this QI project, which Dr. Moravec believes will go to HealthEast’s other two acute care hospitals in nine months, would not be possible without Dr. Frenz’ conversance with problems in the OR.

“When you are involved in this type of process improvement project, you don’t want, as a do-gooder, to create more cancellations and delays,” says Dr. Frenz. “And you don’t want to screw up their referral relationships. You’ve got to be super-sensitive to those issues as you’re trying to slowly bring about change. The fact that I’m known to the surgeons and that I’m in the OR getting dirty lends credibility to our efforts to bring change.”

Value in Surgical Assisting?

In medical school, Dr. Frenz had considered becoming a general surgeon before switching to family-practice medicine, so he is comfortable in the OR and finds assisting to be a stimulating change of pace. Although this long-standing pilot project is unique, it raises provocative possibilities for other hospitalists.

“Having a hospitalist go into the OR to assist with cases creates an interesting situation,” says Richard Rohr, MD, vice president for medical affairs at Cortland Regional Medical Center in Cortland, N.Y. “The hospitalist is then able to engage with more surgical aspects of the case, as well as the medical management.” Adding surgical assisting to the hospitalist’s role—although it could complicate scheduling and malpractice coverage—might dovetail with some hospitals’ difficulties retaining general surgeons, he says.

Combining the two functions could add to the hospital medicine group’s bottom line if relevant malpractice costs could be worked out, says hospitalist Kenneth Patrick, MD, the ICU director at Chestnut Hill Hospital in Philadelphia. Dr. Frenz’ malpractice is provided by his hospital, and pre-certification for his assistance on cases is handled by the neurosurgeon’s office staff.

In Dr. Patrick’s experience, there could be benefits to the patient if the hospitalist has direct involvement in the OR. For instance, the hospitalist would be better able to anticipate and deal with pre- and post-operative problems.

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Surgery and ‘Outer Space’

Whether or not surgical assisting could become a new frontier for hospitalists, it illustrates the multiple collaborative roles the specialty increasingly offers.