Optimize pre-surgical processes: key role of Interna

David Rubal and Juana Carretero during the presentation of the VI Meeting of the Working Group on Shared Assistance and Hospital Medicine (ACyMH) of the SEMI.

Internal medicine doctors Spanish Society of Internal Medicine (SEMI) have gathered in Madrid last Friday, May 6, at the VI Meeting of the Working Group on Shared Assistance and Hospitalist Medicine (ACyMH) of the SEMI, in which a hundred specialists in Internal Medicine from different hospitals in the country. In the course of it, it became clear that “the optimization of the pre-surgical processes with the medical support of internists and their participation in programs Rapid Recovery is a growing need in the face of an increasingly complex patient profile with more comorbidity”.

This makes it possible for the patient “to arrive at surgery in the best possible functional and clinical state and toand recover faster of the same”, since it is optimized prior to hospital admission where later it is also followed in shared care with the surgical service in question. This optimization, in the opinion of Internal Medicine, “is very necessary given the current complexity of surgical patients today due to the increase in age and its associated comorbiditywhich makes medical management by surgical services difficult”.

Precisely, the medical comorbidity is an even more important risk factor than age for the prognosis of surgery and “medical complications -and not derived from surgery itself- are related to at least the 80 percent of surgical deathsjust like him 72 percent of readmissions of surgical patients are for medical reasons.” Precisely at the meeting, different papers were given on “clinical pathways for enhanced recovery in adult surgery and on preoperative prehabilitation.”

In which cases is cooperation between specialists key?

In addition to these aspects, within the framework of the meeting, the role of the consultant internist, news and experiences in the field of shared care, advances in the shared management of surgical and urological patients, the usefulness of clinical ultrasound for the consultant internist or the education and training of residents in these fields and clinical cases have been exposed in these fields.

The meeting was inaugurated by David Rubil, coordinator of the SEMI Shared Assistance and Hospital Medicine Working Group, and of Jane Carter, 1st Vice President of the SEMI. During the meeting it was stressed that “hospitalized patients are increasingly medically complex, and it is necessary that specialists cooperate both in its medical and surgical management”. Shared assistance is cluefor example, in patients with “diabetic foot, hip fracture, in polytraumatized patients or in polypathological patients”.

Shared assistance, “prevailing and necessary”

The aging of the population and the fact that hospitalized patients are increasingly complex and have more comorbidities, multiple pathologies and/or polypharmacy, makes cooperation between specialists “a prevailing and necessary reality”, as stated at the meeting. Thus, from the ACyMH Group it is understood that “every patient hospitalized in a surgical service must receive shared carealthough the fact of being assessed at the beginning of admission does not mean that the intensity applied in the follow-up is the same in all cases, since it must be personalized for each patient and each clinical situation”.

According to the latest available data (2020), the 26 percent of hospitals has doctors Internal Medicine adjuncts dedicated full time to the shared assistance and interconsultation. Traumatology, with special consideration to the hip fracture process, General Surgery and Urology, especially in patients undergoing oncological surgery, whether gastrointestinal or genitourinary, and Vascular Surgery, with the diabetic foot care process, are the surgical services in those in which shared care is performed the most by Internal Medicine.

Besides, eight out of ten requests of interconsultation to the Internal Medicine Services come from surgical specialties. Although Psychiatry, Cardiology and Neurology are some of the medical services that consult Interna the most; In recent years, the shared care model with Internal Medicine has been consolidating in different medical services, for example, working in a multidisciplinary manner “improving the care of cancer and psychiatric patients.”

Most frequent diagnoses in interconsultation

Also, according to the latest available data (2020), among most diagnoses made by the consulting internistThrough interconsultation, they find: anemia (20.1 percent), heart failure (16 percent), respiratory failure (12.8 percent), acute renal failure (12.8 percent), electrolyte disturbances (11.4 percent), and delirium (8 percent), all medical complications frequently handled in conventional medical hospitalization wards, but as frequent or more so in surgical wards.

The average number of interconsultations (traditional or through shared assistance) attended by each Internal Medicine Service is an average of 900 a year (although it is a figure with considerable variability between hospitals).

In the meeting, in addition, the criteria for the “accreditation of units in shared assistance”, as well as the bases and requirements for their accreditation request depending on whether basic or advanced accreditation is requested (IMAS-SEMI criteria). The launch of a course aimed at medical professionals who perform Shared assistance in Traumatology Serviceswhich will address general concepts of organization and management of the shared care model, the main syndromes that an internist can see in a trauma patient, issues related to the optimization of this type of patient both prior to surgery and the management of complications during the immediate postoperative period.

In addition to analyzing the present, past and future of Shared Assistance and Interconsultation in Spain in the master conference; with the participation of experts from other countries, there has also been a discussion on the Hospitalist Medicine in the USA. and the situation of Shared Assistance in Argentina and Latin America.

Finally, the bases for carrying out a new record, driven by internists from the ACyMH-SEMI Group with the aim of improve management of perioperative anemia in patients who undergo a surgical process and the I Eduardo Montero Awards were given to the best clinical cases presented in the field of Shared Care. The Shared Assistance Group currently has 565 internists and develops Registries such as the REINA-SEMI and other research projects and studies.

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