Saik Susan, Sheitman Brian B, Mann Scott, Stelle Walter W, Osberg James W
Dorothea Dix State Psychiatric Hospital in Raleigh, NC 27603, USA.
N C Med J. 2007 Mar-Apr;68(2):95-8.
Dorothea Dix State Psychiatric Hospital (DDH) was cited by regulatory agencies in 1999-2001 for serious deficiencies in providing medical care to psychiatric patients. This resulted in a change in the discipline responsible for providing medical care. We report here how clinical staff and regulatory agencies evaluated the change. In addition, we sought to determine how medical care is currently provided at other state hospital across the nation.
A transition occurred whereby the responsibility for medical care (direct care and supervision of physician extenders) was changed from psychiatrists to internists. We surveyed psychiatrists and nurses about their impressions of the change and calculated the number of citations from regulators pre-and post-changeover. In addition, a survey was sent to all 212 state psychiatric hospitals.
Response rates were: 100% for DDH psychiatrists, 42% for DDH nurses, and 67% for state hospitals. At DDH, clinicians favorably viewed the changeover with 23 (96%) of the 24 psychiatrists reporting a preference for internists having overall responsibility for medical care. There was also a marked reduction in deficiencies cited by regulatory agencies, with 10 prior to the change and only one after the change. Responses to the State Psychiatric Hospital survey revealed that psychiatrists currently provide or are responsible for at least some portion of the medical care at 690% ofall facilities.
DDH staffevaluated a change from a system that had not been in place for 3 years. Quality of care measures were not available. How these data generalize to other state hospitals is unknown.
Having internists responsible for medical care was well received by staff and regulatory agencies. Currently, state psychiatric facilities use different approaches to provide medical care. Further research is needed on how quality of care, and ultimately patient safety, may be impacted by these different service delivery models.
多萝西娅·迪克斯州立精神病医院（DDH）在1999 - 2001年期间被监管机构指出在为精神病患者提供医疗护理方面存在严重缺陷。这导致了负责提供医疗护理的学科发生了变化。我们在此报告临床工作人员和监管机构如何评估这一变化。此外，我们试图确定目前全国其他州立医院是如何提供医疗护理的。
发生了一次转变，即医疗护理责任（直接护理和对医师助理的监督）从精神科医生转交给了内科医生。我们调查了精神科医生和护士对这一变化的看法，并计算了转变前后监管机构开出的罚单数量。此外，还向所有212家州立精神病医院发送了一份调查问卷。
回复率分别为：DDH精神科医生100%，DDH护士42%，州立医院67%。在DDH，临床医生对这一转变持积极看法，24名精神科医生中有23名（96%）表示倾向于由内科医生全面负责医疗护理。监管机构指出的缺陷也显著减少，转变前有10项，转变后只有1项。对州立精神病医院调查的回复显示，在所有机构中，69%的精神科医生目前提供或负责至少部分医疗护理。
DDH工作人员评估的是一个已经3年未实施的系统的变化。没有护理质量衡量标准。这些数据如何推广到其他州立医院尚不清楚。
由内科医生负责医疗护理受到了工作人员和监管机构的好评。目前，州立精神病设施采用不同的方法提供医疗护理。需要进一步研究这些不同的服务提供模式如何影响护理质量以及最终的患者安全。
