Horwood C M, Hakendorf P, Thompson C H
Clinical Epidemiology Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia. Email:.
Discipline of Medicine, North Terrace, University of Adelaide, Adelaide, SA, 5005, Australia.
Aust Health Rev. 2018 Sep;42(5):579-583. doi: 10.1071/AH17197.
Objective The choice of whether to admit under a specialist or a generalist unit is often made with neither clear rationale nor understanding of its consequences. The present study compared the characteristics and outcomes of patients admitted with community-acquired pneumonia to either a general medicine or respiratory unit. Methods This study was a retrospective cross-sectional study using data from public hospitals in Adelaide, South Australia. Over 5 years there were 9775 overnight, unplanned appropriate adult admissions. Patient length of hospital stay, in-patient mortality rate and 30-day unplanned readmission rate were calculated, with and without adjustment for patient age and comorbidity burden. Results Over 80% of these patients were cared for by a general medicine unit rather than a specialist unit. Patients admitted to a general medicine unit were, on average, 4 years older than those admitted to a respiratory unit. Comorbidity burdens were similar between units at the same hospital. Length of in-patient stay was >1 day shorter for those admitted to a general medicine unit, without significant compromise in mortality or readmission rates. Between each hospital, general medicine units showed a range of mortality rates and length of hospital stay, for which there was no obvious explanation. Conclusions Compared with speciality care, general medicine units can safely and efficiently care for patients presenting to hospital with community-acquired pneumonia. What is known about the topic? Within the narrow range of any specific disease, generalist medical services are often cited as inferior in performance compared with a speciality service. This has implications for hospital resourcing, including both staffing and ward allocation. What does this paper add? This paper demonstrates that most patients admitted with a principal diagnosis of community-acquired pneumonia were admitted to a generalist unit and did not apparently fare worse than patients admitted to a specialist service; patients admitted to a generalist unit spent less time in hospital and there was no difference in mortality or readmission rate compared with patients admitted to a specialist service. What are the implications for practitioners? The provision of generalist services at urban hospitals in Australia provides a safe alternative admission option for patients presenting with pneumonia, and possibly for other common acute medical conditions.
选择将患者收治在专科病房还是普通病房，往往既缺乏明确的理由，也不了解其后果。本研究比较了因社区获得性肺炎入院的患者在普通内科病房和呼吸内科病房的特征及治疗结果。方法：本研究是一项回顾性横断面研究，使用了南澳大利亚阿德莱德公立医院的数据。在5年多的时间里，共有9775例过夜、非计划的成年患者入院。计算了患者的住院时间、住院死亡率和30天非计划再入院率，并对患者年龄和合并症负担进行了调整和未调整的分析。结果：这些患者中超过80%由普通内科病房护理，而非专科病房。入住普通内科病房的患者平均比入住呼吸内科病房的患者大4岁。同一医院不同病房的合并症负担相似。入住普通内科病房的患者住院时间缩短超过1天，且死亡率和再入院率没有显著增加。各医院的普通内科病房死亡率和住院时间存在差异，且无明显原因。结论：与专科护理相比，普通内科病房能够安全、有效地护理因社区获得性肺炎入院的患者。关于该主题已知的信息是什么？在任何特定疾病的狭窄范围内，与专科服务相比，全科医疗服务的表现往往被认为较差。这对医院资源配置有影响，包括人员配备和病房分配。本文补充了什么？本文表明，大多数以社区获得性肺炎为主诊断入院的患者被收治在普通病房，且其病情似乎并不比专科服务收治的患者更差；入住普通病房的患者住院时间更短，与专科服务收治的患者相比，死亡率和再入院率没有差异。对从业者有何启示？在澳大利亚城市医院提供全科服务，为肺炎患者以及可能的其他常见急性疾病患者提供了一个安全的替代入院选择。
