Haycock Michael, Stuttaford Laura, Ruscombe-King Oliver, Barker Zoe, Callaghan Kathryn, Davis Timothy
Great Western Hospital, UK.
BMJ Qual Improv Rep. 2014 Nov 14;3(1). doi: 10.1136/bmjquality.u205963.w2604. eCollection 2014.
EDSs are an important part of patient care and medical communication. The GWH has a financially motivated target stating that 95% of EDS are to be completed within 24 hours of patient discharge. On review of a six-week pre-intervention period, the medical ward mean weekly EDS completion rate within 24 hours was 74.3%. EDSs form a significant part of junior doctor workload. We found that on a medical ward the mean completion time for one EDS was 18.25 minutes. In January 2014, 387 EDSs were written between four medical wards. This equates to 29.25 hours per week of junior doctor time spent completing EDSs on the four main medical wards. Our aim was to improve the percentage of EDSs completed within 24 hours of discharge from medical wards in the GWH. We proposed and implemented two interventions: 1) Five day EDS summary 2) Protected EDS hour. The five day EDS summary was implemented on wards 1 and 2. The protected EDS hour on ward 3. Ward 1: mean pre-intervention EDS completion rate: 81.1% (six months pre-intervention). This increased by 7.9% to 89% (four week mean EDS completion rate post-intervention) Ward 2: mean pre-intervention EDS completion rate: 75.2%. This increased by 11.6% to 86.8% Ward 3: mean pre-intervention EDS completion rate: 71%. This increased by 4.5% to 75.5% Control ward: mean pre-intervention EDS completion rate: 85.1%. This increased by 5.1% to 90.2% Our results show the five day EDS summary led to a mean 9.75% improvement and the protected EDS hour a mean 4.5% improvement in EDS completion rates. A 5.1% increase was seen on the control ward suggesting confounding factors in this data which are most likely the trust EDS working group, junior doctor experience and EDS project publicity.
出院小结是患者护理和医疗沟通的重要组成部分。格温特医院（GWH）有一个受经济因素驱动的目标，即95%的出院小结要在患者出院后24小时内完成。在回顾干预前六周期间，内科病房24小时内出院小结的平均每周完成率为74.3%。出院小结构成了初级医生工作量的重要部分。我们发现在内科病房，一份出院小结的平均完成时间为18.25分钟。2014年1月，四个内科病房共撰写了387份出院小结。这相当于初级医生每周花29.25小时在四个主要内科病房完成出院小结。我们的目标是提高格温特医院内科病房出院后24小时内完成出院小结的百分比。我们提出并实施了两项干预措施：1）五天出院小结总结 2）专门的出院小结时间。五天出院小结总结在1号和2号病房实施。3号病房设置了专门的出院小结时间。1号病房：干预前出院小结平均完成率：81.1%（干预前六个月）。这一数字增加了7.9%，达到89%（干预后四周出院小结平均完成率） 2号病房：干预前出院小结平均完成率：75.2%。这一数字增加了11.6%，达到86.8% 3号病房：干预前出院小结平均完成率：71%。这一数字增加了4.5%，达到75.5% 对照病房：干预前出院小结平均完成率：85.1%。这一数字增加了5.1%，达到90.2% 我们的结果显示，五天出院小结总结使出院小结完成率平均提高了9.75%，专门的出院小结时间使完成率平均提高了4.5%。对照病房提高了5.1%，这表明该数据中存在混杂因素，最有可能的是信托出院小结工作组、初级医生经验和出院小结项目宣传。
