Utilization and outcome in the medical patient referred to surgery

The objective of this study was to test the hypothesis that hospitalized patients referred to a general surgical service from a medical service for a surgical procedure would have higher hospital costs and longer lengths of stay per diagnosis-related group (DRG) than patients admitted directly to the general surgical service. Hospital costs by DRG, exclusive of physician's fees, were analyzed for all adult general surgical admissions treated at our hospital from January 1, 1985 to March 31, 1986 (3,028 patients) to yield a population of patients in those DRGs with patients referred to general surgery from medicine (1,495 patients). Patients within each DRG were then disaggregated by either direct admission to general surgery (1,412 patients) or referral to the general surgical service from the medical service (83 patients). Mean cost per patient was 146.5 percent higher for referral patients than for direct admission patients, as was the total length of stay. Mortality was higher for referral patients than for direct admission patients. Factors analyzed which contributed to this greater resource utilization and higher mortality were (1) a greater severity of illness, (2) higher diagnostic costs, and (3) delays in diagnosis or treatment. The DRG payment for referral patients also produced a substantial deficit for the hospital, whereas direct admission patients produced a profit of $1,105,596. This data suggests that direct admission to the surgical service of patients likely to need surgery might lower their hospital costs and improve the quality of their care.