Aicher Brittany O, Hanlon Erin, Rosenberger Sarah, Toursavadkohi Shahab, Crawford Robert S
Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Division of Advanced Practice Providers, Department of Nursing, University of Maryland Medical Center, Baltimore, MD, USA.
J Vasc Nurs. 2019 Jun;37(2):78-85. doi: 10.1016/j.jvn.2018.11.004. Epub 2019 Feb 13.
As the cost of care for patients with specific diagnoses becomes fixed, hospitals must develop systems to reduce length of stay and optimize the use of hospital resources while maintaining a high quality of care. The goal of this study is to evaluate the implementation and efficacy of a system designed to reduce average length of stay on a vascular surgery service. To effectively reduce the average length of stay in our center, we restructured patient rounds, implemented multidisciplinary rounds, introduced clinical pathways to postoperative care, and expanded outpatient management of postoperative patients. A total of 1697 adult vascular surgery patients discharged while under the medical direction of a vascular surgeon between July 1, 2013, and June 30, 2016, were included in the study. Improving communication with critical staff and using procedural space outside of the main operating rooms led to a 2.8-day reduction in the length of stay (10.8 vs 8.0, P < .001). There was a trend toward a reduction in the 30-day readmission rate (12% vs 10%, respectively; P = .01) and no significant difference in the case-mix index as a measure of illness severity (2.5 vs 2.4, respectively; P = .15). Length of stay reductions were heterogeneous among the types of vascular diseases studied, with greater improvements seen in patients undergoing lower extremity amputation, lower extremity angiogram, and endovascular aneurysm repair for nonruptured abdominal aortic aneurysms. Less pronounced differences were observed in patients undergoing carotid artery endarterectomy or stenting and lower extremity bypasses. In conclusion, restructuring team rounds and instituting a multidisciplinary approach to discharge planning produced significant reductions in length of stay without a deleterious effect on patient care which may impact hospital profitability.
随着针对特定诊断患者的护理成本固定下来，医院必须建立系统，以缩短住院时间并优化医院资源的使用，同时保持高质量的护理。本研究的目的是评估一种旨在缩短血管外科服务平均住院时间的系统的实施情况和效果。为了有效缩短我们中心的平均住院时间，我们重组了患者查房流程，实施了多学科查房，引入了术后护理临床路径，并扩大了对术后患者的门诊管理。本研究纳入了2013年7月1日至2016年6月30日期间在血管外科医生医疗指导下出院的1697例成年血管外科患者。改善与关键工作人员的沟通以及利用主手术室之外的手术空间，使住院时间缩短了2.8天（分别为10.8天和8.0天，P <.001）。30天再入院率有下降趋势（分别为12%和10%；P = 0.01），作为疾病严重程度衡量指标的病例组合指数无显著差异（分别为2.5和2.4；P = 0.15）。在所研究的血管疾病类型中，住院时间的缩短存在差异，在接受下肢截肢、下肢血管造影以及非破裂腹主动脉瘤的血管内动脉瘤修复的患者中改善更为明显。在接受颈动脉内膜切除术或支架置入术以及下肢搭桥手术的患者中观察到的差异不太明显。总之，重组团队查房并采用多学科方法进行出院计划，可显著缩短住院时间，且对患者护理无有害影响，这可能会影响医院的盈利能力。
