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“Daily medical liaison is associated with reduced length of stay in a regional vascular surgery service: a before-and-after study.”
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  • Emma Mitchell,
  • Roisin Coary,
  • Paul WhiteOrcid,
  • Emily Farrow,
  • Amy Crees,
  • William Beedham,
  • Mark Devine,
  • Rebecca Winterborn,
  • David Shipway
Emma Mitchell
North Bristol NHS Trust
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Roisin Coary
St James's Hospital
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Paul White
Orcid
University of the West of England Bristol
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Emily Farrow
North Bristol NHS Trust
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Amy Crees
North Bristol NHS Trust
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William Beedham
North Bristol NHS Trust
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Mark Devine
North Bristol NHS Trust
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Rebecca Winterborn
North Bristol NHS Trust
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David Shipway
North Bristol NHS Trust
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Peer review status:UNDER REVIEW

12 May 2020Submitted to International Journal of Clinical Practice
13 May 2020Assigned to Editor
13 May 2020Submission Checks Completed
27 Jul 2020Reviewer(s) Assigned

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.