Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins University School of Nursing, Baltimore, MD, USA.
J Eval Clin Pract. 2018 Aug;24(4):713-717. doi: 10.1111/jep.12949. Epub 2018 May 25.
"Attending rotations" on intensive care unit (ICU) services have been in place in most teaching hospitals for decades. However, the ideal frequency of patient care handoffs is unknown. Frequent attending physician handoffs could result in delays in care and other complications, while too few handoffs can lead to provider burnout and exhaustion. Therefore, we sought to determine the correlation between frequency of attending shifts with ICU charges, 30-day readmission rates, and mortality rates.
We performed a retrospective cohort study at a large, urban, academic community hospital in Baltimore, MD. We included patients admitted into the cardiac or medical ICUs between September 1, 2012, and December 10, 2015. We tracked the number of attending shifts for each patient and correlated shifts with financial outcomes as a primary measure.
For any given ICU length of stay, we found no distinct association between handoff frequency and charges, 30-day readmission rates, or mortality rates.
Despite frequent handoffs in care, there was no objective evidence of care compromise or differences in cost. Further validation of these observations in a larger cohort is justified.
在大多数教学医院中，重症监护病房（ICU）的“轮班”已经存在了几十年。然而，目前仍不清楚患者护理交接的理想频率。频繁的主治医生交接可能会导致护理延迟和其他并发症，而交接太少则会导致提供者倦怠和疲惫。因此，我们试图确定主治医生轮班频率与 ICU 费用、30 天再入院率和死亡率之间的相关性。
我们在马里兰州巴尔的摩市的一家大型城市学术社区医院进行了回顾性队列研究。我们纳入了 2012 年 9 月 1 日至 2015 年 12 月 10 日期间入住心脏或内科 ICU 的患者。我们跟踪了每位患者的主治医生轮班次数，并将轮班次数与财务结果作为主要衡量标准进行了关联。
对于任何特定的 ICU 住院时间，我们都没有发现交接频率与费用、30 天再入院率或死亡率之间存在明显的关联。
尽管护理交接频繁，但没有客观证据表明护理质量下降或成本存在差异。在更大的队列中进一步验证这些观察结果是合理的。
