Bardes James M, Khan Uzer, Cornell Nicole, Wilson Alison
Division of Trauma, Acute Care Surgery and Critical Care, Department of Surgery, West Virginia University, Morgantown, West Virginia.
Division of Trauma, Acute Care Surgery and Critical Care, Department of Surgery, West Virginia University, Morgantown, West Virginia.
J Surg Res. 2017 Jun 1;213:1-5. doi: 10.1016/j.jss.2017.02.018. Epub 2017 Feb 23.
Trauma patients represent a high-volume and high-acuity population. This makes discharge planning difficult. Discharged by noon is a metric shown to correlate with hospital throughput. Improvements in efficiency will be needed to improve resource utilization and increase discharge by noon rate. This study aimed to evaluate the impact of a standardized discharge team on length of stay and discharge by noon.
A university level I trauma center implemented a discharge team composed of a trauma attending and an advanced practice provider. This team is tasked with evaluating patients on the discharge list daily. This allowed patients ready for discharge to be evaluated and discharged before noon. A retrospective review was performed to analyze discharge by noon rates before and after implementation of the discharge team.
A total of 3053 patients were discharged before the implementation of the discharge team and 3801 after. Discharges by noon increased from 25.5% to 51.2% in the post. For patients with an injury severity score >15, this same improvement was seen, 22.5% to 51.9%. Similar improvements were seen when controlling for final discharge disposition and primary payer status.
By establishing a separate discharge team, large improvements can be seen in the discharge by noon rate. These improvements were maintained when controlling for injury severity score, final discharge disposition, and insurance status. Significant savings are possible in both charges to the patient and direct costs to the facility. The utilization of a discharge team should be considered at similar facilities.
创伤患者数量众多且病情严重，这使得出院计划制定困难。中午前出院是一项与医院吞吐量相关的指标。需要提高效率以改善资源利用并提高中午前出院率。本研究旨在评估标准化出院团队对住院时间和中午前出院的影响。
一所大学一级创伤中心组建了一个由创伤主治医生和高级执业提供者组成的出院团队。该团队负责每天评估出院清单上的患者。这使得准备好出院的患者能够在中午前接受评估并出院。进行了一项回顾性分析，以分析出院团队实施前后的中午前出院率。
在出院团队实施前共有3053例患者出院，实施后有3801例。实施后中午前出院率从25.5%提高到51.2%。对于损伤严重程度评分>15的患者，也有同样的改善，从22.5%提高到51.9%。在控制最终出院处置和主要支付方状态时也观察到了类似的改善。
通过组建一个单独的出院团队，中午前出院率可大幅提高。在控制损伤严重程度评分、最终出院处置和保险状态时，这些改善得以维持。在患者费用和机构直接成本方面都有可能实现显著节省。类似的机构应考虑采用出院团队。
