Ross M A, Naylor S, Compton S, Gibb K A, Wilson A G
Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
Ann Emerg Med. 2001 Mar;37(3):267-74. doi: 10.1067/mem.2001.111519.
We sought to determine whether sharing an observation unit with scheduled procedure patients would maintain a more consistent unit census and patient/nurse ratio. A secondary objective was to determine the effect of this model on patient length of stay and discharge rates.
This retrospective, descriptive study was conducted in a high-volume suburban teaching hospital, using a "before-and-after" study design. A "pure" postprocedure unit became a "hybrid" observation postprocedure unit by displacing specific postprocedure patients to inpatient locations. Subsequently, the displaced patients were returned to the unit. On weekends, the unit operated as a pure observation unit. Hourly unit occupancy and census data were prospectively collected, and hourly patient/nurse ratios were calculated. Patient length of stay and discharge data were collected and compared in different settings.
The 2 services showed a complementary census pattern that allowed the hybrid unit to maintain an average hourly patient/nurse ratio of 3.7 compared with the ratio of 2.5 for a pure observation unit. There was no difference in observation patient length of stay (14.8 hours versus 14.7 hours) or discharge rate (20.4% versus 18.1%) between weekdays and weekends. However, scheduled procedure patients experienced significantly shorter lengths of stay in the hybrid unit setting (4.3 hours) than in alternative inpatient locations (9.4 hours).
The hybrid model showed better hourly census and nurse resource use rates, with no adverse effect on observation patients. However, scheduled procedure patient length of stay was shorter in this setting.
我们试图确定与接受预定手术的患者共用一个观察单元是否能维持更稳定的单元患者总数和患者/护士比例。第二个目的是确定这种模式对患者住院时间和出院率的影响。
这项回顾性描述性研究在一家大型郊区教学医院进行，采用“前后”研究设计。一个“纯粹”的术后单元通过将特定的术后患者转移到住院病房而变成了一个“混合”观察术后单元。随后，被转移的患者又回到了该单元。在周末，该单元作为一个纯粹的观察单元运行。前瞻性地收集每小时的单元占用率和患者总数数据，并计算每小时的患者/护士比例。收集并比较不同情况下患者的住院时间和出院数据。
这两种服务呈现出互补的患者总数模式，使得混合单元的平均每小时患者/护士比例为3.7，而纯粹观察单元的这一比例为2.5。工作日和周末之间，观察患者的住院时间（14.8小时对14.7小时）或出院率（20.4%对18.1%）没有差异。然而，在混合单元环境中，接受预定手术的患者的住院时间（4.3小时）明显短于在其他住院病房（9.4小时）。
混合模式显示出更好的每小时患者总数和护士资源使用率，且对观察患者没有不利影响。然而，在这种环境下，接受预定手术的患者住院时间较短。
