Department of Palliative Medicine, Medical Faculty of the University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany.
Support Care Cancer. 2018 Feb;26(2):673-679. doi: 10.1007/s00520-017-3893-3. Epub 2017 Sep 17.
Palliative care (PC) involves many health care providers leading to a high complexity of structures that requires efficient coordination as provided by case management (CM). Our study aimed to evaluate the effects of CM newly implemented in a specialised palliative care unit by evaluating team members' tasks and time resources before (T0) and after implementation (T1). It was hypothesised that team members would be able to spend less time on organisational and administrative tasks and more time on patient care.
A prospective pre-post study design was used. Time distribution of different tasks at T0 and T1 was compared between three different professional groups: physicians, nursing staff and social work. To document their tasks and time required, a documentation form with several items for each profession was developed. Data was analysed using t tests for independent samples.
After Bonferroni correction, a significant pre-post difference was found for the time spent on "discharge interview and discharge" as rated by the physicians (p < .001) with less time spent on this activity after CM implementation. The nursing staff had significantly more time for "conversations with patients" (p < .001) after CM implementation. Moreover, they spent significantly less time on "patient-related requests/advice by telephone" (p < .001) and "discussions with relatives/participation in family discussions" at post-assessment (p < .001). The social worker had significantly more time for "patient advice and support services" (p = .013) after CM implementation.
Integrating CM can be time efficient and ensures team members to spend more time on their core tasks in patient care.
姑息治疗（PC）涉及许多医疗保健提供者，导致结构高度复杂，需要由个案管理（CM）提供有效的协调。我们的研究旨在评估新实施的专门姑息治疗病房中的 CM 对团队成员的任务和时间资源的影响，在实施前后（T0 和 T1）进行评估。假设团队成员能够将更多的时间用于患者护理，减少组织和行政任务的时间。
采用前瞻性前后研究设计。在 T0 和 T1 时，使用独立样本 t 检验比较了三种不同专业群体（医生、护理人员和社会工作者）的不同任务的时间分配。为了记录他们的任务和所需时间，为每个专业开发了一个带有多个项目的文档表单。
在 Bonferroni 校正后，医生评定的“出院访谈和出院”时间有显著的前后差异（p < 0.001），实施 CM 后，他们在这项活动上花费的时间减少了。护理人员进行“与患者的谈话”的时间明显增加（p < 0.001）。此外，他们在“通过电话与患者相关的请求/建议”（p < 0.001）和“与亲属讨论/参加家庭讨论”（p < 0.001）的时间明显减少。实施 CM 后，社会工作者有更多的时间用于“患者建议和支持服务”（p = 0.013）。
整合 CM 可以提高效率，确保团队成员将更多的时间用于患者护理的核心任务。
