Virginia Mason Medical Center, Seattle, WA, USA.
Hosp Pract (1995). 2021 Dec;49(5):371-375. doi: 10.1080/21548331.2021.1985316. Epub 2021 Oct 6.
Unit-based teams may improve care delivery for hospitalized patients but can be challenging to implement broadly across all acute care units in a hospital.
To determine the effect of a Lean-guided transition to hospital-wide unit-based assignment on care delivery outcomes.
DESIGN, SETTING, AND PARTICIPANTS: The study was a retrospective time-series with primary outcomes of discharge efficiency, 30-day readmissions, and length of stay, performed at a 336-bed tertiary academic referral hospital in the Pacific Northwest with approximately 17,000 admissions annually.
Implementation of a Lean-guided quality improvement intervention included division of hospitalist duties into 'admitters' and 'rounders,' with simulated patient flow exercises to determine the optimal staffing model.
Discharge efficiency (number of patients discharged by hospitalists divided by the number of hospitalist patient encounter days per month) and 30-day readmissions were compared using the t-test or chi-square, and length of stay was analyzed in a multivariate time-series regression model.
The intervention was associated with a significant improvement in discharge efficiency, by 0.014 (from 0.168 to 0.181) discharges/encounter (95% CI = 0.024, 0.004), p = 0.009. Mean length of stay decreased by 0.98 days (95% CI 0.50, 1.47) after adjustment for patient age, patient type (medical versus surgical), critical care admissions, and discharge disposition, without a corresponding change in 30-day readmission rate (12.2% (1948/15,902) pre-intervention to 11.7% (397/3379) post-intervention (p = 0.42)).
Dividing hospitalist roles into admitters and rounders enabled implementation of unit-based teams across the hospital, with corresponding improvements in discharge efficiency and length of stay.
基于单元的团队可以改善住院患者的护理服务，但在医院内所有急症护理单元广泛实施可能具有挑战性。
确定向全院基于单元的分配转变的精益指导对护理服务结果的影响。
设计、设置和参与者：这项研究是一项回顾性时间序列研究，主要结局为出院效率、30 天再入院率和住院时间，在西北太平洋地区的一家拥有 336 张床位的三级学术转诊医院进行，每年约有 17000 名患者入院。
实施精益指导的质量改进干预措施，包括将医院医生的职责分为“接诊医生”和“巡诊医生”，并进行模拟患者流程练习，以确定最佳人员配备模式。
使用 t 检验或卡方检验比较出院效率（由医院医生出院的患者数量除以每月医院医生患者就诊天数）和 30 天再入院率，使用多元时间序列回归模型分析住院时间。
干预措施与出院效率的显著提高相关，提高了 0.014（从 0.168 提高到 0.181）次/次就诊（95%CI=0.024，0.004），p=0.009。调整患者年龄、患者类型（内科与外科）、重症监护入院和出院处置后，平均住院时间缩短了 0.98 天（95%CI 0.50，1.47），而 30 天再入院率没有相应变化（12.2%（1948/15902）干预前至 11.7%（397/3379）干预后（p=0.42））。
将医院医生的角色划分为接诊医生和巡诊医生，可以在全院实施基于单元的团队，相应地提高出院效率和住院时间。
