晨间汇报可缩短创伤患者的住院时间。
Morning report decreases length of stay in trauma patients.
作者信息
Wolfe John D, Gardner James R, Beck William C, Taylor John R, Bhavaraju Avi, Davis Ben, Kimbrough Mary Katherine, Robertson Ronald D, Karim Saleema A, Sexton Kevin W
机构信息
Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA.
Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
出版信息
Trauma Surg Acute Care Open. 2018 Sep 8;3(1):e000185. doi: 10.1136/tsaco-2018-000185. eCollection 2018.
BACKGROUND
Modern acute care surgery (ACS) programs depend on consistent patient hand-offs to facilitate care, as most programs have transitioned to shift-based coverage. We sought to determine the impact of implementing a morning report (MR) model on patient outcomes in the trauma service of a tertiary care center.
METHODS
The University of Arkansas for Medical Sciences (UAMS) Division of ACS implemented MR in October 2015, which consists of the trauma day team, the emergency general surgery day team, and a combined night float team. This study queried the UAMS Trauma Registry and the Arkansas Clinical Data Repository for all patients meeting the National Trauma Data Bank inclusion criteria from January 1, 2011 to April 30, 2018. Bivariate frequency statistics and generalized linear model were run using STATA V.14.2.
RESULTS
A total of 11 253 patients (pre-MR, n=6556; post-MR, n=4697) were analyzed in this study. The generalized linear model indicates that implementation of MR resulted in a significant decrease in length of stay (LOS) in trauma patients.
DISCUSSION
This study describes an approach to improving patient outcomes in a trauma surgery service of a tertiary care center. The data show how an MR session can allow for patients to get out of the hospital faster; however, broader implications of these sessions have yet to be studied. Further work is needed to describe the decisions being made that allow for a decreased LOS, what dynamics exist between the attendings and the residents in these sessions, and if these sessions can show some of the same benefits in other surgical services.
LEVEL OF EVIDENCE
Level 4, Care Management.
背景
现代急性护理手术（ACS）项目依赖于持续的患者交接以促进护理，因为大多数项目已过渡到基于轮班的覆盖模式。我们试图确定在一家三级护理中心的创伤科实施早交班（MR）模式对患者预后的影响。
方法
阿肯色大学医学科学部（UAMS）的ACS部门于2015年10月实施了MR，其由创伤日间团队、急诊普通外科日间团队和联合夜间值班团队组成。本研究查询了UAMS创伤登记处和阿肯色临床数据存储库中2011年1月1日至2018年4月30日期间所有符合国家创伤数据库纳入标准的患者。使用STATA V.14.2进行双变量频率统计和广义线性模型分析。
结果
本研究共分析了11253例患者（MR实施前，n = 6556；MR实施后，n = 4697）。广义线性模型表明，MR的实施导致创伤患者住院时间（LOS）显著缩短。
讨论
本研究描述了一种改善三级护理中心创伤外科服务患者预后的方法。数据显示了早交班环节如何能让患者更快出院；然而，这些环节的更广泛影响尚待研究。需要进一步开展工作来描述促使住院时间缩短的决策、这些环节中主治医师和住院医师之间存在何种动态关系，以及这些环节在其他外科服务中是否能显示出一些相同的益处。
证据级别
4级，护理管理。
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