Department of Gastroenterology, Royal Bolton Hospital NHS Foundation Trust, Farnworth, Bolton, Lancs, UK.
Postgrad Med J. 2012 Oct;88(1044):583-7. doi: 10.1136/postgradmedj-2012-100033rep.
For gastroenterology, The Royal College of Physicians reiterates the common practice of two to three consultant ward rounds per week. The Royal Bolton Hospital NHS Foundation Trust operated a 26-bed gastroenterology ward, covered by two consultants at any one time. A traditional system of two ward rounds per consultant per week operated, but as is commonplace, discharges peaked on ward round days.
To determine whether daily consultant ward rounds would improve patient care, shorten length of stay and reduce inpatient mortality.
A new way of working was implemented in December 2009 with a single consultant taking responsibility for all ward inpatients. Freed from all other direct clinical care commitments for their 2 weeks of ward cover, they conducted ward rounds each morning. A multidisciplinary team (MDT) meeting followed immediately. The afternoon was allocated to gastroenterology referrals and reviewing patients on the medical admissions unit.
The changes had an immediate and dramatic effect on average length of stay, which was reduced from 11.5 to 8.9 days. The number of patients treated over 12 months increased by 37% from 739 to 1010. Moreover, the number of deaths decreased from 88 to 62, a reduction in percentage mortality from 11.2% to 6%. However, these major quality outcomes involved a reduction in consultant-delivered outpatient and endoscopy activity.
This new method of working has both advantages and disadvantages. However, it has had a major impact on inpatient care and provides a compelling case for consultant gastroenterology expansion in the UK.
对于胃肠病学，英国皇家内科医师学会重申了每周进行两到三次顾问查房的常见做法。皇家博尔顿医院国民保健信托基金会经营着一个有 26 张床位的胃肠病学病房，由两名顾问同时负责。当时实行的是每周每位顾问进行两次查房的传统制度，但正如常见的那样，出院人数在查房日达到高峰。
确定每日顾问查房是否会改善患者护理，缩短住院时间并降低住院死亡率。
2009 年 12 月实施了一种新的工作方式，由一位顾问负责所有住院患者。他们在两周的病房轮值期间，免除了所有其他直接临床护理职责，可以每天早上进行查房。随后立即举行多学科团队（MDT）会议。下午则用于处理胃肠病学转诊和审查内科住院病人。
这些变化对平均住院时间产生了立竿见影的显著影响，从 11.5 天缩短至 8.9 天。在 12 个月内接受治疗的患者人数增加了 37%，从 739 人增加到 1010 人。此外，死亡人数从 88 人减少到 62 人，死亡率从 11.2%降至 6%。然而，这些主要的质量结果涉及顾问提供的门诊和内镜检查活动减少。
这种新的工作方式有其优点和缺点。然而，它对住院患者护理产生了重大影响，并为英国顾问扩大胃肠病学提供了有力的理由。
