Stier Gary, Ramsingh Davinder, Raval Ronak, Shih Gary, Halverson Bryan, Austin Briahnna, Soo Joseph, Ruckle Herbert, Martin Robert
1Anesthesiology, Internal Medicine and Critical Care, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354 USA.
2Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354 USA.
Perioper Med (Lond). 2018 Jun 19;7:13. doi: 10.1186/s13741-018-0090-y. eCollection 2018.
Perioperative care has been identified as an area of wide variability in quality, with conflicting models, and involving multiple specialties. In 2014, the Loma Linda University Departments of Anesthesiology and Urology implemented a perioperative hospitalist service (PHS), consisting of anesthesiology-trained physicians, to co-manage patients for the entirety of their perioperative period. We hypothesized that implementation of this PHS model would result in an improvement in patient recovery.
As a quality improvement (QI) initiative, the PHS service was formed of selected anesthesiologists who received training on the core competencies for hospitalist medicine. The service was implemented following a co-management agreement to medically manage patients undergoing major urologic procedures (prostatectomy, cystectomy, and nephrectomy). Impact was assessed by comparisons to data from the year prior to PHS service implementation. Data was compared with and without propensity matching. Primary outcome marker was a reduction in length of stay. Secondary outcome markers included complication rate, return of bowel function, number of consultations, reduction in total direct patient costs, and bed days saved.
Significant reductions in length of stay ( < 0.05) were demonstrated for all surgical procedures with propensity matching and were demonstrated for cystectomy and nephrectomy cases without. Significant reductions in complication rates and ileus were also observed for all surgical procedures post-PHS implementation. Additionally, reductions in total direct patient costs and frequency of consultations were also observed.
Anesthesiologists can safely function as perioperative hospitalists, providing appropriate medical management, and significantly improving both patient recovery and throughput.
围手术期护理已被确定为质量差异很大的领域，存在相互冲突的模式，且涉及多个专业。2014年，洛马林达大学麻醉学和泌尿学系实施了围手术期住院医师服务（PHS），该服务由经过麻醉学培训的医生组成，负责在患者整个围手术期进行共同管理。我们假设实施这种PHS模式将改善患者康复情况。
作为一项质量改进（QI）举措，PHS服务由选定的麻醉师组成，这些麻醉师接受了住院医师医学核心能力培训。该服务是根据共同管理协议实施的，旨在对接受主要泌尿外科手术（前列腺切除术、膀胱切除术和肾切除术）的患者进行医疗管理。通过与PHS服务实施前一年的数据进行比较来评估影响。数据进行了有无倾向匹配的比较。主要结局指标是住院时间缩短。次要结局指标包括并发症发生率、肠道功能恢复情况、会诊次数、患者直接总费用降低以及节省的住院天数。
在进行倾向匹配的情况下，所有手术的住院时间均显著缩短（<0.05），在未进行倾向匹配的膀胱切除术和肾切除术病例中也观察到显著缩短。在实施PHS后，所有手术的并发症发生率和肠梗阻也显著降低。此外，还观察到患者直接总费用降低以及会诊频率降低。
麻醉师可以安全地担任围手术期住院医师，提供适当的医疗管理，并显著改善患者康复情况和诊疗效率。
