O'Donnell Christopher M, Stern Marsha, Leong Traci, Molitch-Hou Ethan, Mitchell Bruce
Emory University, Atlanta, GA.
Am J Med Qual. 2019 Nov/Dec;34(6):553-560. doi: 10.1177/1062860618818355. Epub 2018 Dec 20.
Little research in hospital medicine examines the effects of hospitalist continuity on patient outcomes. This study implemented a novel staffing model with approximately half of rounding teams starting their 7-day workweek on Monday and the others on Friday. Teams admitted their own patients on their first 4 days with additional nighttime admissions handed off to those teams. No admissions were given to teams on their last 3 days. Length of stay was significantly reduced from 6.34 days in 2015 to 5.7 days in 2016 ( < .002) with a significant decrease in handoffs. There was an increase in odds ratio of death (1.37, SE = .128) with each additional hospitalist involved in a patient's care while adjusting for year and number of patient diagnoses ( < .001). There was no statistical difference in charges, 30-day readmissions, or mortality between years.
医院医学领域中，很少有研究探讨住院医师连续性对患者治疗结果的影响。本研究实施了一种新颖的人员配置模式，约一半的查房团队从周一开始为期7天的工作周，另一半从周五开始。各团队在工作的前4天接收自己的患者，额外的夜间入院患者则交接给这些团队。在工作的最后3天，各团队不接收新入院患者。住院时间从2015年的6.34天显著缩短至2016年的5.7天（P<0.002），且交接显著减少。在对年份和患者诊断数量进行调整后，每增加一名参与患者护理的住院医师，死亡比值比增加（1.37，标准误=0.128）（P<0.001）。不同年份之间在费用、30天再入院率或死亡率方面无统计学差异。
