Kulaga Mark E, Charney Pamela, O'Mahony Stephen P, Cleary Joseph P, McClung Timothy M, Schildkamp Donald E, Mazur Eric M
Department of Medicine, Yale University School of Medicine, Norwalk Hospital, Norwalk, CT 06856, USA.
J Gen Intern Med. 2004 Apr;19(4):293-301. doi: 10.1111/j.1525-1497.2004.30552.x.
Although hospitalists have been shown to improve both financial and educational outcomes, their ability to manage dual roles as clinicians and educators has been infrequently demonstrated, particularly in the community setting where large numbers of residents train. We evaluated the impact of hospitalists on financial and educational outcomes at a mid-sized community teaching hospital 1 year after implementation.
Two hospitalist clinician educators (HCEs) were hired to provide inpatient medical care while participating in resident education. Length of stay and cost per case data were calculated for all patients admitted to the hospitalist service during their first year and compared with patients admitted to private physicians. The hospitalists' top 11 discharge diagnoses were individually assessed. For the same time period, categorical medicine residents (N = 36) were given an anonymous written survey to assess the HCEs' impact on resident education and service.
Resource consumption: length of stay was reduced by 20.8% and total cost per case was reduced by 18.4% comparing the HCEs with community-based physicians. Reductions in both length of stay and cost per case were noted for 8 of the 11 most common discharge diagnoses. Resident survey: over 75% of residents responded, with all noting improvement in the quality of attending rounds, bedside teaching, and the overall inpatient experience. Residents' roles as teachers and team leaders were largely unchanged.
Hospitalist clinician educators as inpatient teaching attendings effectively reduce length of stay and resource utilization while improving resident education at community-based teaching hospitals.
尽管已证明住院医师能改善财务和教育成果，但他们作为临床医生和教育工作者履行双重角色的能力却鲜有体现，尤其是在有大量住院医师培训的社区环境中。我们评估了在一家中型社区教学医院实施一年后，住院医师对财务和教育成果的影响。
聘请了两名住院医师临床教育工作者（HCEs），在参与住院医师教育的同时提供住院医疗服务。计算了第一年期间入住住院医师服务的所有患者的住院时间和每例病例的费用，并与入住私人医生处的患者进行比较。对住院医师的前11项出院诊断进行了单独评估。在同一时期，对36名内科住院医师进行了匿名书面调查，以评估HCEs对住院医师教育和服务的影响。
资源消耗：与社区医生相比，HCEs的住院时间缩短了20.8%，每例病例的总成本降低了18.4%。11种最常见的出院诊断中有8种的住院时间和每例病例费用均有所降低。住院医师调查：超过75%的住院医师做出了回应，所有人都指出主治医师查房、床边教学和整体住院体验的质量有所改善。住院医师作为教师和团队领导者的角色基本没有变化。
住院医师临床教育工作者作为住院教学主治医师，能有效缩短住院时间、降低资源利用，同时改善社区教学医院的住院医师教育。
