Medicine, Southland Hospital, Invercargill, Southland, New Zealand
Medicine, Taranaki Base Hospital, New Plymouth, Taranaki, New Zealand.
BMJ Open Qual. 2022 Jun;11(2). doi: 10.1136/bmjoq-2021-001606.
Surgical inpatients referred to medicine with acute medical problems represent a complex patient population, vulnerable to fragmented care and suboptimal outcomes. They can also be a source of staff dissatisfaction in busy or understaffed departments. Comanagement by surgical and medical staff may improve outcomes but requires dedicated resources and the evidence for other interventions is scarce. We aimed to assess staff experience, demographics and clinical outcomes of this patient population at our hospital and develop an intervention aiming to improve medical staff experience, without compromising clinical outcomes.Staff were surveyed before and after the intervention to measure staff experience. Demographics and clinical outcomes were collected for 60 referrals at baseline and 29 referrals postintervention (an e-referral system linked to locally developed clinical pathways). Clinical outcomes were delay time (time from referral submission to review), length of stay, 30-day mortality and 30-day readmissions.Medical staff experience improved from majority negative or neutral ratings to majority positive ratings postintervention and 100% of staff surveyed supported ongoing use of the intervention. There were no negative impacts on clinical outcomes, which acted as balancing measures.Medical staff experience improved, without compromising clinical outcomes. The e-referral system doubles as a platform for ongoing quality improvement.
因急性医学问题被转至内科的外科住院患者构成了一个复杂的患者群体，他们容易面临治疗碎片化和治疗效果欠佳等问题。在繁忙或人手不足的科室中，这些患者还可能导致医护人员不满。外科和内科医护人员共同管理此类患者可能会改善治疗效果，但需要专门的资源，且其他干预措施的证据也很少。我们旨在评估我院此类患者的医护人员体验、人口统计学特征和临床结局，并制定一项干预措施，在不影响临床结局的情况下改善医护人员的体验。在干预措施前后，我们对医护人员进行了调查，以评估其体验。我们收集了 60 例基线转科患者和 29 例转科后患者（与本地开发的临床路径相关联的电子转科系统）的人口统计学特征和临床结局。临床结局包括延迟时间（从转科提交到审查的时间）、住院时间、30 天死亡率和 30 天再入院率。在干预措施后，医护人员的体验从多数负面或中性评价转变为多数正面评价，且 100%接受调查的医护人员支持继续使用该干预措施。该干预措施对临床结局没有负面影响，这起到了平衡作用。该干预措施改善了医护人员的体验，且没有影响临床结局。电子转科系统也可作为持续质量改进的平台。
