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在7天工作、7天休息的住院医师模式中纳入连续性以及与患者交接和住院时间的相关性。

Incorporating Continuity in a 7-On 7-Off Hospitalist Model and the Correlation With Patient Handoffs and Length of Stay.

作者信息

O'Donnell Christopher M, Stern Marsha, Leong Traci, Molitch-Hou Ethan, Mitchell Bruce

机构信息

Emory University, Atlanta, GA.

出版信息

Am J Med Qual. 2019 Nov/Dec;34(6):553-560. doi: 10.1177/1062860618818355. Epub 2018 Dec 20.

Abstract

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.

摘要

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。

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