Metzinger Candice, Antonios Sam, Kallail K James, Okut Hayrettin, Zackula Rosey, Cline Brianna
University of Kansas School of Medicine-Wichita, Wichita, KS.
Ascension Via Christi St. Francis, Wichita, KS.
Kans J Med. 2021 Aug 4;14(2):192-196. doi: 10.17161/kjm.vol1415170. eCollection 2021.
Few studies have quantified the total number of attending and consulting physicians involved in inpatients' care, and no other research quantifies the total number of all providers participating in inpatients' care. The purpose of this study was to calculate the number of attending hand-offs, the attending encounter time, and the total number of providers participating in inpatients' care for all admitted patients at a tertiary urban medical center.
The study design was an observational retrospective cohort. Subjects included pediatric and adult patients who were admitted to and discharged from Ascension Via Christi St. Francis (AVCSF) in Wichita, Kansas between November 1, 2019 and January 31, 2020. Data were abstracted from the Cerner Electronic Medical Record. Variables included: patient demographics, admitting diagnosis, diagnosis related group (DRG), admission service, and duration of inpatient stay. Provider variables abstracted included provider type and provider specialty. Categorical variables were presented as frequencies and percentages, while continuous variables were presented as means ± standard deviation.
The sample included information from 200 patient charts. Patients' ages ranged from 5 to 94 years, with a mean of 61 years. Approximately 52% were female and 74.9% were admitted to a surgical service. The length of all inpatients' stays ranged from less than 1 day to 31 days, with a mean of 4 days. Seventy-six different DRGs were recorded. The most frequent attending specialties were hospital medicine, internal medicine, general surgery, and interventional cardiology. Consulting physicians had more patient encounters than any other healthcare provider. For all inpatients, an average of two attending physicians participated in care over the duration of their stay with a range of one to six attending physicians. There was an average of one hand-off between attending physicians. Patients had an average of five consulting physicians, two resident physicians, two physician assistants, and two nurse practitioners during a stay. There was an average of 10 total providers, with a range of one to 46 total providers participating in care.
Understanding the provider data surrounding an inpatient stay is a foundational step in assessing the quality of the provider-inpatient encounter and potential areas for improvement. In this study, the average number of attending physicians and handoffs was reasonable; however, the total number of providers involved in care was relatively high. Assessment of staffing and scheduling requirements by hospital administration could identify areas of improvement to reduce the potential for medical error caused by multiple providers being involved in patient care.
很少有研究对参与住院患者护理的主治医生和会诊医生的总数进行量化，也没有其他研究对参与住院患者护理的所有医护人员的总数进行量化。本研究的目的是计算一家城市三级医疗中心所有入院患者的主治医生交接次数、主治医生诊疗时间以及参与住院患者护理的医护人员总数。
本研究设计为观察性回顾性队列研究。研究对象包括2019年11月1日至2020年1月31日期间在堪萨斯州威奇托市的阿森松Via Christi圣弗朗西斯医院（AVCSF）入院并出院的儿科和成年患者。数据从Cerner电子病历中提取。变量包括：患者人口统计学信息、入院诊断、诊断相关分组（DRG）、入院科室以及住院时间。提取的医护人员变量包括医护人员类型和专业。分类变量以频率和百分比表示，连续变量以均值±标准差表示。
样本包括来自200份患者病历的信息。患者年龄范围为5至94岁，平均年龄为61岁。约52%为女性，74.9%入住外科科室。所有住院患者的住院时间从不到1天到31天不等，平均为4天。记录了76种不同的DRG。最常见的主治专业是医院医学、内科、普通外科和介入心脏病学。会诊医生的患者诊疗次数比其他任何医护人员都多。对于所有住院患者，在住院期间平均有两名主治医生参与护理，范围为一至六名主治医生。主治医生之间平均有一次交接。患者住院期间平均有五名会诊医生、两名住院医生、两名医师助理和两名执业护士。参与护理的医护人员总数平均为10名，范围为一至46名。
了解住院期间的医护人员数据是评估医护人员与患者诊疗质量及潜在改进领域的基础步骤。在本研究中，主治医生的平均数量和交接次数是合理的；然而，参与护理的医护人员总数相对较高。医院管理部门对人员配备和排班要求进行评估可以确定改进领域，以减少多名医护人员参与患者护理导致医疗差错的可能性。
