Eagle K A, Mulley A G, Skates S J, Reder V A, Nicholson B W, Sexton J O, Barnett G O, Thibault G E
Medical Services, Massachusetts General Hospital, Boston 02114.
JAMA. 1990;264(8):992-7.
We developed consensus management guidelines for patients admitted with chest pain, pulmonary edema, and syncope and used these guidelines to examine practice variation and the effects of physician feedback on decision making in 1145 consecutive admissions to three medical intensive care units. Data collection included a 6-month baseline period and two 6-month physician feedback periods. Hospital length of stay fell from 8.34 days to 7.41 and 7.14 days during feedback; intensive care unit length of stay fell from 2.45 days to 2.23 and 2.07 days. Feedback was associated with an increase in the percentage of patients conforming to the management guidelines. Multiple linear regression showed that feedback correlated with reductions of 0.79 days (confidence interval, 0.12 to 1.46) in hospital length of stay and 0.21 days (confidence interval 0.05 to 0.37) in intensive care unit length of stay. This effect was most apparent in patients not requiring any intervention, but with a major complication. During the 6-month follow-up, mortality, readmission, and urgent readmission rates were similar for patients admitted in baseline and feedback periods.
我们制定了针对胸痛、肺水肿和晕厥入院患者的共识管理指南，并使用这些指南来研究实践差异以及医师反馈对三个医疗重症监护病房连续1145例入院患者决策的影响。数据收集包括一个6个月的基线期和两个6个月的医师反馈期。在反馈期间，住院时间从8.34天降至7.41天和7.14天；重症监护病房住院时间从2.45天降至2.23天和2.07天。反馈与符合管理指南的患者百分比增加相关。多元线性回归显示，反馈与住院时间减少0.79天（置信区间为0.12至1.46）以及重症监护病房住院时间减少0.21天（置信区间为0.05至0.37）相关。这种效果在不需要任何干预但有重大并发症的患者中最为明显。在6个月的随访期间，基线期和反馈期入院患者的死亡率、再入院率和紧急再入院率相似。
