Koo Douglas J, Goring Tabitha N, Saltz Leonard B, Kerpelev Marina, Kumar Chhavi B, Salvit Cori, Chung Helen H, Abou-Alfa Ghassan K, Martin Steven C, Egan Barbara C
Memorial Sloan Kettering Cancer Center, New York, NY
Memorial Sloan Kettering Cancer Center, New York, NY.
J Oncol Pract. 2015 Mar;11(2):e114-9. doi: 10.1200/JOP.2014.000661. Epub 2015 Jan 6.
Hospitalists provide quality care in various inpatient settings, but the ability of hospitalists to provide quality inpatient care for patients with complex cancer has not been studied. This study explores outcomes with a hospitalist-led versus medical oncologist-led house staff team on an inpatient medical GI oncology teaching service.
This observational retrospective cohort study examined 829 patient discharges from August 2012 to January 2013 on the GI oncology inpatient teaching service at Memorial Sloan Kettering Cancer Center, a tertiary cancer center in New York, New York. We compared average length of stay (ALOS), 30-day readmission rates, establishment of new do not resuscitate (DNR) orders, nosocomial pneumonia and urinary tract infection (UTI) rates, radiographic and laboratory tests per patient, and disposition on discharge between hospitalist-led and oncologist-led teams.
Median years of clinical experience was 6 (range, 4 to 9 years) for hospitalists and 7 (range, 0.5 to 36 years) for oncologists. ALOS (hospitalist led, 5.6 v oncologist led, 5.2 days; P = .30), readmission within 30 days (hospitalist led, 14% v oncologist led, 16%; P = .44), new DNR orders (hospitalist led, 18% v oncologist led, 19%; P = .90), nosocomial pneumonia (hospitalist led, 0.5% v oncologist led, 0.7%; P = .63) and UTI rates (hospitalist led, 0.5% v oncologist led, 0.7%; P = .63), number of radiographic studies and laboratory tests, and disposition on discharge were not significantly different between groups.
A hospitalist-led inpatient service with house staff represents a novel approach for caring for hospitalized GI oncology patients with cancer.
住院医师在各种住院环境中提供优质护理，但住院医师为患有复杂癌症的患者提供优质住院护理的能力尚未得到研究。本研究探讨了在住院胃肠肿瘤学教学服务中，由住院医师主导的团队与医学肿瘤学家主导的住院医师团队的治疗结果。
这项观察性回顾性队列研究检查了2012年8月至2013年1月在纽约市纪念斯隆凯特琳癌症中心（一家三级癌症中心）的胃肠肿瘤学住院教学服务中829例患者的出院情况。我们比较了住院医师主导的团队和肿瘤学家主导的团队之间的平均住院时间（ALOS）、30天再入院率、新的不要复苏（DNR）医嘱的开具情况、医院获得性肺炎和尿路感染（UTI）发生率、每位患者的影像学和实验室检查以及出院处置情况。
住院医师的临床经验中位数为6年（范围为4至9年），肿瘤学家为7年（范围为0.5至36年）。平均住院时间（住院医师主导，5.6天；肿瘤学家主导，5.2天；P = 0.30）、30天内再入院率（住院医师主导，14%；肿瘤学家主导，16%；P = 0.44）、新的DNR医嘱（住院医师主导，18%；肿瘤学家主导，19%；P = 0.90）、医院获得性肺炎（住院医师主导，0.5%；肿瘤学家主导，0.7%；P = 0.63）和尿路感染发生率（住院医师主导，0.5%；肿瘤学家主导，0.7%；P = 0.63）、影像学检查和实验室检查的数量以及出院处置情况在两组之间无显著差异。
由住院医师主导并配备住院医师的住院服务是一种照顾住院癌症胃肠肿瘤患者的新方法。
