Navani Vishal
Brighton and Sussex University Hospitals NHS Trust.
BMJ Qual Improv Rep. 2013 Oct 25;2(2). doi: 10.1136/bmjquality.u202304.w1138. eCollection 2014.
Regular consultant ward rounds have been shown to reduce the length of stay and improve the discharge planning for patients (1). To balance the competing demands of outpatient activity and inpatient oncology, it has been difficult to provide specialist care in our hospital. Previously, inpatients were managed primarily by the oncology specialist trainees, who are qualified in internal medicine, with an ad-hoc review by their named consultant. A regular consultant ward round was introduced for the first time on the 7/1/13. Each consultant was timetabled to give a twice weekly morning ward round on a rolling rota. To evaluate this intervention, a retrospective case note analysis was undertaken. This included all patients admitted under oncology for the two months preceding and succeeding the new ward round. For each patient the admission date, time to first consultant review, number of consultant reviews, time to discharge after consultant review, and discharge date was identified. A staff survey also took place. Statistical analysis was performed using Mann-Whitney U or Chi-Squared tests. 85 patient episodes met the inclusion criteria. Case notes were available for 63 episodes (74%). The average length of stay significantly decreased from 11 days to three and half days (p<0.05). The time to discharge after first consultant review also significantly decreased from six days to two days (p<0.05). The number of consultant reviews and time to first consultant review remained unchanged (p>0.05). The percentage of patients receiving a consultant review increased, from 54.3% to 71.4%, though this was not statistically significant. However it is likely such a large increase is clinically significant. Medical and nursing staff satisfaction also improved. This study suggests that a regular consultant ward round improves length of stay for patients. This is possibly because an increase in patients received a consultant review and that the treatment and discharge decisions were expedited after such a review.
定期的顾问查房已被证明可缩短患者住院时间并改善出院计划(1)。为平衡门诊活动和住院肿瘤治疗的相互竞争需求，在我们医院提供专科护理一直很困难。以前，住院患者主要由具备内科资质的肿瘤专科实习医生管理，由指定的顾问医生进行临时查房。2013年1月7日首次引入了定期的顾问查房。每位顾问医生安排在滚动排班表上每周进行两次上午查房。为评估这一干预措施，进行了回顾性病例记录分析。这包括在新查房前后两个月内所有因肿瘤住院的患者。对于每位患者，确定入院日期、首次顾问查房时间、顾问查房次数、顾问查房后出院时间以及出院日期。还进行了一次员工调查。使用曼-惠特尼U检验或卡方检验进行统计分析。85例患者符合纳入标准。63例（74%）有病例记录。平均住院时间从11天显著缩短至3.5天（p<0.05）。首次顾问查房后出院时间也从6天显著缩短至2天（p<0.05）。顾问查房次数和首次顾问查房时间保持不变（p>0.05）。接受顾问查房的患者百分比从54.3%增加到71.4%，尽管这在统计学上不显著。然而，如此大幅的增加很可能具有临床意义。医护人员的满意度也有所提高。这项研究表明，定期的顾问查房可缩短患者住院时间。这可能是因为接受顾问查房的患者增多，且查房后治疗和出院决策加快。
