Sommers L S, Schurman D J, Jamison J Q, Woolson S T, Robison B L, Silverman J F
Department of Diagnostic Radiology and Nuclear Medicine, Stanford University School of Medicine, California.
Clin Orthop Relat Res. 1990 Sep(258):168-75.
Can patients treated with total hip arthroplasty (THA) receive high-quality inpatient care at less cost? In 1984, a group of orthopedic surgeons and nurses examined the use of resources for THA patients and changed certain clinical practices to promote more cost-effective hospital care. At the end of the two-year project, orders for complete blood counts fell 72% and mean operating room time dropped 47 minutes for the participating orthopedists. For all orthopedists in the division, average length of stay (ALOS) decreased from 13 to 11 days. By the end of the following year, when clinicians received quarterly length-of-stay (LOS) data, ALOS dropped further to 9.8 days. This significant ALOS reduction was not accompanied by an increase in hospital readmissions or nursing home placements. The ALOS reduction was also not seen in elective coronary artery bypass graft patients whose ALOS did not substantially change over the same period. Two years after the project, ALOS for THA patients remained at ten days or below. This reduction in LOS and in the use of other hospital services translated into a mean total hospital charge decrease of $2045 per THA patient.
接受全髋关节置换术（THA）的患者能否以更低的成本获得高质量的住院护理？1984年，一组骨科外科医生和护士对THA患者的资源使用情况进行了检查，并改变了某些临床实践，以促进更具成本效益的医院护理。在为期两年的项目结束时，参与项目的骨科医生的全血细胞计数检查订单减少了72%，平均手术室时间缩短了47分钟。对于该科室的所有骨科医生来说，平均住院时间（ALOS）从13天降至11天。到次年年底，当临床医生收到季度住院时间（LOS）数据时，ALOS进一步降至9.8天。这种显著的ALOS缩短并没有伴随着医院再入院率或疗养院安置率的增加。同期，择期冠状动脉搭桥术患者的ALOS没有实质性变化，也未出现ALOS缩短的情况。项目开展两年后，THA患者的ALOS仍保持在10天或以下。LOS的缩短以及其他医院服务使用的减少，使得每位THA患者的平均总住院费用降低了2045美元。
