英国医院内科急症入院患者中，顾问医生专业对出院决策的影响。

Impact of consultant specialty on discharge decisions in patients admitted as medical emergencies to hospitals in the United Kingdom.

作者信息

Subbe C P, Jeune Ivan Le, Ward D, Pradhan S, Masterton-Smith C

机构信息

From Bangor University, School of Medical Sciences, Bangor, UK.

Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma (DREEAM), Nottingham University Hospitals NUH Trust, Nottingham, UK.

出版信息

QJM. 2017 Feb 1;110(2):97-102. doi: 10.1093/qjmed/hcw173.

DOI:10.1093/qjmed/hcw173

PMID:27795294

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5939643/

Abstract

BACKGROUND

The Society for Acute Medicine's Benchmarking Audit (SAMBA) annually examines Clinical Quality Indicators (CQIs) of the care of patients admitted to UK hospitals as medical emergencies.

AIM

The aim of this study is to review the impact of consultant specialty on discharge decisions in the SAMBA data-set.

DESIGN AND METHODS

Prospective audit of patients admitted to acute medical units (AMUs) on 25 June 2015 to participating hospitals throughout the UK with subgroup analysis.

RESULTS

Eighty-three units submitted patient data from 3138 patients.Nearly 1845 (58%, IQR for units 50-69%) of patients were referrals from Emergency Medicine, 1072 (32%, IQR for units 24-44%) were referrals from Primary Care. The mean age was 65 (SD 20). One hundred and forty-one (4.5%) patients were admitted from care homes and 951 (30%) of patients were at least 'mildly frail' and 407 (13%) had signs of physiological instability. The median and the mean time to being seen by a doctor were 1 h 20 min and 2 h 3 min, respectively. The median and the mean time to being seen by senior specialist were 3 h 55 min and 5 h 56 min, respectively. By 72 h, 29 (1%) patients had died in the AMU, 73 were admitted to critical care units, 1297 (41%) had been discharged to their own home and 60 to nursing or residential homes. For every 100 patients seen specialists in acute medicine discharged 12 more patients than specialists from other disciplines of medicine ( P < 0.001). The difference remained significant after adjustment for case mix.

CONCLUSION

Specialist in acute care might facilitate discharge in a higher proportion of patients.

摘要

背景

急性医学学会的基准审计（SAMBA）每年都会对因医疗紧急情况入住英国医院的患者的临床质量指标（CQIs）进行检查。

目的

本研究的目的是在SAMBA数据集中评估顾问专科对出院决策的影响。

设计与方法

对2015年6月25日入住英国各地参与研究医院的急性医疗单元（AMUs）的患者进行前瞻性审计，并进行亚组分析。

结果

83个单元提交了3138例患者的数据。近1845例（58%，各单元的四分位距为50 - 69%）患者是由急诊科转诊而来，1072例（32%，各单元的四分位距为24 - 44%）是由初级保健机构转诊而来。平均年龄为65岁（标准差20）。141例（4.5%）患者从养老院入院，951例（30%）患者至少“轻度虚弱”，407例（13%）有生理不稳定迹象。患者见到医生的中位时间和平均时间分别为1小时20分钟和2小时3分钟。见到高级专科医生的中位时间和平均时间分别为3小时55分钟和5小时56分钟。到72小时时，29例（1%）患者在急性医疗单元死亡，73例被收入重症监护病房，1297例（41%）已出院回家，60例出院至护理院或养老院。每100例由急性医学专科医生诊治的患者比其他医学专科医生多出院12例（P < 0.001）。在对病例组合进行调整后，差异仍然显著。