Gonzalo Jed D, Kuperman Ethan F, Chuang Cynthia H, Lehman Erik, Glasser Frendy, Abendroth Thomas
Pennsylvania State University College of Medicine, Hershey, PA, USA.
University of Iowa Carver College of Medicine, Iowa City, IA, USA.
J Gen Intern Med. 2015 Dec;30(12):1795-802. doi: 10.1007/s11606-015-3389-0. Epub 2015 May 20.
Many academic hospitals have implemented overnight hospitalists to supervise house staff and improve outcomes, but few studies have described the impact of this role.
To investigate the effect of an overnight academic hospitalist program on patient-level outcomes. Secondary objectives were to describe the program's revenue generation and work tasks.
Retrospective interrupted time-series analysis of patients admitted to the medicine service before and after implementation of the program.
All patients aged 18 and older admitted to the acute or intermediate care units between 7:00 p.m. and 6:59 a.m. during the period before (April 2011-August 2012) and after (September 2012-April 2014) program implementation.
An on-site attending-level physician directly supervising medicine house staff overnight, providing clinical care during high-volume periods, and ensuring safe handoffs to daytime providers.
Primary outcomes included in-hospital mortality, 30-day hospital readmissions, length of stay, and upgrades in care on the night of admission and during hospitalization. Multivariable models estimated the effect on outcomes after adjusting for secular trends. Revenue generation and work tasks are reported descriptively.
During the study period, 6484 patients were admitted to the medicine service: 2722 (42 %) before and 3762 (58 %) after implementation. No differences were found in mortality (1.1 % vs. 0.9 %, p=0.38), 30-day readmissions (14.8 % vs. 15.6 %, p=0.39), mean length of stay (3.09 vs. 3.08 days, p=0.86), or upgrades to intensive care on the night of admission (0.4 % vs. 0.7 %, p=0.11) or during hospitalization (3.5 % vs. 4.2 %, p=0.20). During the first year, hospitalists billed 1209 patient encounters (3.3/shift) and 63 procedures (0.2/shift), and supervised 1939 patient admissions (6.12/shift) while supervising house staff 3-h/shifts.
Implementation of an overnight academic hospitalist program showed no impact on several important clinical outcomes, and revenue generation was modest. As overnight hospitalist programs develop, investigations are needed to delineate the return on investment and focus on other outcomes that may be more sensitive to change, such as errors and provider/patient satisfaction.
许多学术型医院已实施夜间住院医师制度，以监督住院医生并改善治疗效果，但很少有研究描述这一角色的影响。
调查夜间学术型住院医师项目对患者层面治疗效果的影响。次要目的是描述该项目的创收情况和工作任务。
对该项目实施前后内科收治患者进行回顾性中断时间序列分析。
2011年4月至2012年8月（项目实施前）以及2012年9月至2014年4月（项目实施后）期间，晚上7点至次日早上6点59分入住急性或中级护理病房的所有18岁及以上患者。
一名现场主治级医生在夜间直接监督内科住院医生，在高峰期提供临床护理，并确保向日间医护人员进行安全交接。
主要结局包括住院死亡率、30天内再入院率、住院时间，以及入院当晚和住院期间护理级别提升情况。多变量模型在调整长期趋势后估计对结局的影响。对创收情况和工作任务进行描述性报告。
在研究期间，内科共收治6484例患者：项目实施前2722例（42%），实施后3762例（58%）。在死亡率（1.1%对0.9%，p = 0.38）、30天再入院率（14.8%对15.6%，p = 0.39）、平均住院时间（3.09天对3.08天，p = 0.86），或入院当晚（0.4%对0.7%，p = 0.11）或住院期间（3.5%对4.2%，p = 0.20）升级到重症监护方面，未发现差异。在第一年，住院医师开出1209次患者诊疗账单（每班3.3次）和63项操作账单（每班0.2次），监督1939例患者入院（每班6.12例），同时每班监督住院医生3小时。
实施夜间学术型住院医师项目对多项重要临床结局无影响，创收微薄。随着夜间住院医师项目的发展，需要进行调查以明确投资回报率，并关注其他可能对变化更敏感的结局，如差错以及医护人员/患者满意度。
