英国一家大型教学医院每日两次的会诊病房查房以及临床投入对检查和药房成本的成本效益分析。

A cost-benefit analysis of twice-daily consultant ward rounds and clinical input on investigation and pharmacy costs in a major teaching hospital in the UK.

作者信息

Ahmad Aftab, Weston Philip J, Ahmad Mahin, Sharma Dushyant, Purewal Tejpal

机构信息

Department of Diabetes/Endocrinology and General Medicine, Royal Liverpool University Hospital, Liverpool, Merseyside, UK.

Department of General Medicine, Royal Liverpool University Hospital, Liverpool, Merseyside, UK.

出版信息

BMJ Open. 2015 Apr 8;5(4):e007367. doi: 10.1136/bmjopen-2014-007367.

DOI:10.1136/bmjopen-2014-007367

PMID:25854972

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4390722/

Abstract

OBJECTIVES

Misuse of investigations, medications and hospital beds is costing the National Health Service (NHS) billions of pounds with little evidence that approaches centred on reducing overuse are sustainable. Our previous study demonstrated that twice-daily consultant ward rounds reduce inpatient length of stay and suggested a reduction in overuse of investigations and medications. This study aims to assess the impact of daily consultant ward rounds on the use of investigations and medications and estimate the potential cost benefit.

SETTINGS

The study was performed on two medical wards in a major city university teaching hospital in Liverpool, UK, receiving acute admissions from medical assessment and emergency departments.

PARTICIPANTS AND INTERVENTION

The total number of patients admitted, investigations performed and pharmacy costs incurred were collected for 2 years before and following a change in the working practice of consultants from twice-weekly to twice-daily consultant ward rounds on the two medical wards.

OUTCOME MEASURES

We performed a cost-benefit analysis to assess the net amount of money saved by reducing inappropriate investigations and pharmacy drug use following the intervention.

RESULTS

Despite a 70% increase in patient throughput (p<0.01) the investigations and pharmacy, costs per patient reduced by 50% over a 12-month period (p<0.01) and were sustained for the next 12 months. The reduction in investigations and medication use did not have any effect on the readmission or mortality rate (p=NS), whereas, the length of stay was almost halved (p<0.01). Daily senior clinician input resulted in a net cost saving of £336,528 per year following the intervention.

CONCLUSIONS

Daily consultant input has a significant impact on reducing the inappropriate use of investigations and pharmacy costs saving the NHS more than £650K on the two wards over a 2-year period.

摘要

目的

检查、药物和病床的滥用正在使国民医疗服务体系（NHS）花费数十亿英镑，而几乎没有证据表明以减少过度使用为中心的方法是可持续的。我们之前的研究表明，每天两次的会诊查房可缩短住院时间，并表明检查和药物的过度使用有所减少。本研究旨在评估每日会诊查房对检查和药物使用的影响，并估计潜在的成本效益。

背景

该研究在英国利物浦一家大型城市大学教学医院的两个内科病房进行，接收来自医学评估和急诊科的急性入院患者。

参与者和干预措施

在两个内科病房的会诊工作方式从每周两次改为每天两次会诊查房之前和之后的2年里，收集了入院患者总数、进行的检查以及产生的药房费用。

结果指标

我们进行了成本效益分析，以评估干预后通过减少不适当的检查和药房药物使用所节省的净金额。

结果

尽管患者流量增加了70%（p<0.01），但在12个月期间每位患者的检查和药房费用降低了50%（p<0.01），并在接下来的12个月里保持这一水平。检查和药物使用的减少对再入院率或死亡率没有任何影响（p=无显著差异），而住院时间几乎减半（p<0.01）。干预后，每日高级临床医生的参与每年净节省成本336,528英镑。