医院医师、护士和护理助理使用简短的应用程序指导的谵妄识别协议的相关薪酬成本比较。
Comparative salary-related costs of a brief app-directed delirium identification protocol by hospitalists, nurses, and nursing assistants.
机构信息
College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.
The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA.
出版信息
J Am Geriatr Soc. 2022 Aug;70(8):2371-2378. doi: 10.1111/jgs.17789. Epub 2022 Apr 20.
BACKGROUND
Systematic screening can improve delirium identification among hospitalized older adults. Prior studies have shown clinicians and health system leaders may believe they do not have the time and resources for assessment. We conducted a comparative salary-related cost analysis of an adaptive delirium identification protocol directed by an iPad app.
METHODS
We recruited 527 older adult medicine patients from an urban academic medical center (n = 269) and a rural community hospital (n = 258). Physicians and nurses completed the two-step Ultra-brief Confusion Assessment Method (UB-CAM) protocol (with or without a skip pattern), while certified nursing assistants completed only the UB-2 ultra-brief screen. The sample included 527 patients (average age 80, 57% women, 35% with dementia). Time required to administer the protocol was collected automatically by the iPad app. Salary-related costs of screening were determined by multiplying the time required by the hourly wage for the three disciplines, as obtained from national and regional published healthcare salary cost data. Cost estimates for entire hospital implementation were also calculated.
RESULTS
Participants were screened on 924 hospital days by 399 clinicians (53 physicians, 236 nurses, 110 CNAs). For the UB-2, CNAs cost per screen was lower than the other clinician types ($0.37 per screen vs. $0.73 for nurses and $2.39 for hospitalists). For the UB-CAM with skip (UB-CAM), costs per protocol were $1.10 for nurses vs. $3.61 for physicians. The annual salary-related costs of hospital-wide implementation of a nurse-based UB-CAM protocol in a medium-sized (300-bed) hospital was $63,015 plus $4356 for initial and annual training.
CONCLUSIONS
CNAs and nurses had the lowest salary-associated costs for app-directed CAM-based delirium screening and identification, respectively. Salary-related annual hospital costs for the most efficient protocols in a medium-sized hospital were less than the annual cost of hiring 1 FTE of the discipline performing the protocols.
背景
系统筛查可以提高住院老年患者的谵妄识别率。先前的研究表明，临床医生和卫生系统领导者可能认为他们没有时间和资源进行评估。我们对由 iPad 应用程序指导的适应性谵妄识别协议进行了比较薪资相关成本分析。
方法
我们从一家城市学术医疗中心（n=269）和一家农村社区医院（n=258）招募了 527 名老年医学患者。医生和护士完成了两步式超简短混乱评估方法（UB-CAM）协议（带或不带跳过模式），而认证护理助理仅完成 UB-2 超简短筛查。该样本包括 527 名患者（平均年龄 80 岁，57%为女性，35%患有痴呆症）。iPad 应用程序自动记录协议所需的时间。通过乘以从国家和地区发布的医疗保健薪资成本数据中获得的三个学科的每小时工资，确定筛查的薪资相关成本。还计算了整个医院实施的成本估算。
结果
共有 399 名临床医生（53 名医生、236 名护士、110 名认证护理助理）在 924 个住院日对参与者进行了筛查。对于 UB-2，认证护理助理的每次筛查成本低于其他临床医生类型（每次筛查 0.37 美元，护士为 0.73 美元，医院医生为 2.39 美元）。对于带跳过模式的 UB-CAM（UB-CAM），每次协议的成本分别为护士 1.10 美元，医生 3.61 美元。在一家中等规模（300 张床位）医院中，全面实施以护士为基础的 UB-CAM 协议的年度薪资相关成本为 63,015 美元，外加初始和年度培训费用 4356 美元。
结论
认证护理助理和护士分别进行基于应用程序的 CAM 为导向的谵妄筛查和识别的薪资相关成本最低。在中等规模医院中，效率最高的协议的年度医院薪资相关成本低于雇用执行协议的学科的 1 个全职员工的年度成本。
Zotero 插件