Orewa Gregory N, Feldman Sue S, Hearld Kristine Ria, Kennedy Kierstin Cates, Hall Allyson G
Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, United States of America (Mr Orewa and Drs Feldman, Hearld, and Hall); and UAB Hospital Medicine, University of Alabama at Birmingham, Birmingham (Dr Kennedy).
Qual Manag Health Care. 2022;31(1):22-27. doi: 10.1097/QMH.0000000000000320. Epub 2021 Aug 3.
Hospitals worldwide are faced with the problem of discharging patients on time. Delayed discharge creates domino effects with significant implications for hospitals. The accountable care team (ACT) is a multidisciplinary, unit-based approach to identifying opportunities to improve patient care and address inefficiencies in care delivery and throughput, including assuring timely discharges. In response to concerns about emergency department boarding times and delays in timely discharge, the ACT recommended a set of strategies to improve communication across team members and to reduce wait times for transportation within and outside the hospital. Collectively these strategies were thought to increase the proportion of patients discharged on time. In this article, we describe and assess changes in timely discharge resulting from the implementation of strategies recommended by the ACT.
This study uses a retrospective, quasi-experimental design to compare the percentage of discharges by 1 pm of hospital units implementing the ACT intervention to those units not implementing the intervention. Median discharge time was compared pre- and post-implementation using the Wilcoxon rank sum test. Difference-in-differences modeling was employed to assess whether changes in the percentage of discharges by 1 pm differed between units implementing the intervention and units not implementing the intervention.
One month post-implementation, the percentage discharged by 1 pm was statistically significantly higher for units implementing the intervention (53.6%) compared with comparison units (22.5%, t = -4.48, P < .01). Statistically significant differences in the percentage discharged by 1 pm were also seen at 3 and 6 months post-implementation. The median discharge time showed a statistically significant decrease by 77 minutes from the baseline to intervention period ( P < .01).
The result from the study suggests that ACTs can be used to develop approaches aimed at improving patient care in general, and discharge efficiencies in particular. Health care organizations are encouraged to utilize and then evaluate the specific activities of multidisciplinary teams aimed at developing recommendations for practice improvement.
全球医院都面临着患者按时出院的问题。延迟出院会产生多米诺效应，给医院带来重大影响。 accountable care团队（ACT）是一种基于科室的多学科方法，用于识别改善患者护理的机会，并解决护理交付和流程中的低效问题，包括确保及时出院。针对对急诊科候诊时间和及时出院延迟的担忧，ACT推荐了一系列策略，以改善团队成员之间的沟通，并减少医院内部和外部的转运等待时间。总体而言，这些策略被认为可以提高按时出院患者的比例。在本文中，我们描述并评估了ACT推荐策略实施后及时出院情况的变化。
本研究采用回顾性准实验设计，比较实施ACT干预的医院科室与未实施干预的科室在下午1点前出院的百分比。使用Wilcoxon秩和检验比较实施前后的中位出院时间。采用差异-in-差异模型评估实施干预的科室与未实施干预的科室在下午1点前出院百分比的变化是否存在差异。
实施干预一个月后，实施干预的科室下午1点前出院的百分比（53.6%）与对照组（22.5%）相比，在统计学上有显著差异（t = -4.48，P <.01）。在实施干预后的3个月和6个月，下午1点前出院百分比也存在统计学上的显著差异。中位出院时间从基线期到干预期在统计学上显著减少了77分钟（P <.01）。
研究结果表明，ACT可用于制定旨在总体上改善患者护理，特别是出院效率的方法。鼓励医疗保健组织利用并评估多学科团队的具体活动，以制定改进实践的建议。
