Department of Medicine, University of Toronto, Ont., Canada; Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada.
Department of Medicine, University of Toronto, Ont., Canada; Division of General Internal Medicine, University of Toronto, Ont., Canada.
Am J Med. 2016 Jul;129(7):706-714.e2. doi: 10.1016/j.amjmed.2016.02.022. Epub 2016 Mar 11.
Physician call schedules are a critical element for medical practice and hospital efficiency. We compared readmission rates prior to and after a change in physician call system at Sunnybrook Health Sciences Centre.
We studied patients discharged over a decade (2004 through 2013) and identified whether or not each patient was readmitted within the subsequent 28 days. We excluded patients discharged for a surgical, obstetrical, or psychiatric diagnosis. We used time-to-event analysis and time-series analysis to compare rates of readmission prior to and after the physician call system change (January 1, 2009).
A total of 89,697 patients were discharged, of whom 10,001 (11%) were subsequently readmitted and 4280 died. The risk of readmission was increased by about 26% following physician call system change (9.7% vs 12.2%, P <.001). Time-series analysis confirmed a 26% increase in the readmission rate after call system change (95% confidence interval, 22%-31%; P <.001). The increase in readmission rate after call system change persisted across patients with diverse ages, estimated readmission risks, and medical diagnoses. The net effect was equal to 7240 additional patient days in the hospital following call system change. A modest increase was observed at a nearby acute care hospital that did not change physician call system, and no increase in risk of death was observed with increased hospital readmissions.
We suggest that changes in physician call systems sometimes increase subsequent hospital readmission rates. Further reductions in readmissions may instead require additional resources or ingenuity.
医师轮班制度是医疗实践和医院效率的关键要素。我们比较了在 Sunnybrook 健康科学中心医师轮班制度改变前后的再入院率。
我们研究了十多年来（2004 年至 2013 年）出院的患者，并确定每位患者是否在随后的 28 天内再次入院。我们排除了因手术、产科或精神科诊断而出院的患者。我们使用生存分析和时间序列分析来比较医师轮班制度改变前后（2009 年 1 月 1 日）的再入院率。
共有 89697 名患者出院，其中 10001 名（11%）随后再次入院，4280 名死亡。轮班制度改变后，再入院的风险增加了约 26%（9.7%比 12.2%，P <.001）。时间序列分析证实，轮班制度改变后，再入院率增加了 26%（95%置信区间，22%-31%；P <.001）。轮班制度改变后再入院率的增加在年龄、估计再入院风险和医疗诊断各异的患者中持续存在。轮班制度改变后，相当于有 7240 名患者额外住院。附近一家未改变医师轮班制度的急性护理医院观察到适度增加，且增加医院再入院并未导致死亡风险增加。
我们建议，医师轮班制度的改变有时会增加随后的医院再入院率。相反，要进一步降低再入院率，可能需要额外的资源或创造力。
