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OBJECTIVES: A number of surgery practice models have been developed to address general and trauma surgeon work-force shortages and on-call issues, and to improve surgeon satisfaction. These include the creation of acute or urgent care surgery services and "surgical hospitalist" programs. To date, no practice models corresponding to those developed for general and trauma surgeons have been proposed to address these same issues among vascular surgeons or other surgical subspecialists. In 2003, we initiated a "Vascular Surgery Hospitalist" program (VSHP) within an academic department of surgery. We evaluated the impact of the VSHP on patient care, hospital resource utilization, resident teaching, and surgeon satisfaction since its establishment in 2003.
METHODS: Hospital databases were reviewed to obtain in-patient census information and determine operating room utilization by the vascular surgery service. In addition, billing records were used to evaluate the clinical productivity of the vascular hospitalist (VH) since the establishment of the VSHP. Surgery residents and attendings were surveyed for their opinions regarding the VSHP. HCAHPS survey results were reviewed in order to evaluate patient satisfaction with the care provided by the VH on the vascular surgery unit.
RESULTS: On average, the VH performed 1.6 operative cases, billed 11 E&M charges and read 14 vascular laboratory studies daily. Although the average inpatient acuity scores has not changed since the establishment of the VSHP, the proportion of off-hour operative cases has declined from 8.4% to 3.5%, and the average LOS has decreased from 7.2 to 5.1 days. HCAHPS surveys reveal that throughout the past two years more than 90% of patients admitted to the vascular surgery unit were satisfied with the attention and communication provided by their physicians. VSHP survey results are shown in Table 1.
CONCLUSIONS: Benefits of a VSHP include improved surgeon satisfaction, resource utilization, timeliness of patient care, communication among referring physicians and ancillary staff, and housestaff supervision. Elements of this program may be applicable to a variety of surgical subspecialty settings.

Survey of Attitudes Related to the VSHP. Percent Responding Improved or Dramatically Improved.

	Vascular Faculty (n=8)	Resident/Fellow (n=24)
Personal career satisfaction	75%	N/A
Personal productivity and time management	100%	58%
Timeliness of patient care	88%	75%
OR scheduling and availability	50%	67%
Resident training and supervision	65%	67%
Overall quality of care	88%	75%
Resource utilization	88%	83%
Length of stay	100%	71%
Overall satisfaction with the VSHP	75%	83%