“Daily medical liaison is associated with reduced length of stay in a regional vascular surgery service: a before-and-after study.”

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.