Acad Med. 2024 Jun 1;99(6):618-622. doi: 10.1097/ACM.0000000000005671. Epub 2024 Feb 27.
Approximately 100,000 individuals in the United States have sickle cell disease (SCD). These individuals face multiple barriers to equitable care. At Brigham and Women's Hospital, existing health inequities for these patients were compounded by admitting, rounding, and team structures that assigned patients with SCD to multiple medicine teams with a hematologist attending, leading to delays in patient care and gaps in residents' hematology knowledge.
A hematology-general medicine hybrid team was created in September 2021 to enhance trainee knowledge, skill, and confidence in managing hematology conditions and improve the quality of care delivered to individuals with SCD. This allowed for regionalization of patients with classical hematology conditions to specific hospital floors under the care of one team with a hematologist as the attending of record.
From October 1, 2021, to January 11, 2022, the majority (745/824, 90%) of in-hospital days for patients with a primary hematology diagnosis were under the care of the hematology-general medicine hybrid team. Regionalization to the home floor of the hybrid team was achieved on 331 (40%) of these 824 hospital days, consistent with regionalization rates for other teams. From October 1, 2021, to September 30, 2022, there were 128 unique patients with SCD admitted over 511 encounters and cared for by approximately 78 residents and 12 medical students. Feedback from residents reported improved knowledge in the management of hematology conditions, especially SCD.
The authors are working on a comprehensive analysis of the hybrid team's impact on trainee skill and confidence in managing SCD. The authors believe that this model can be replicated at other institutions to optimize trainee education, consolidate care, and address implicit bias against patients with SCD, even with the hematology attending as a consultant instead of as the attending of record.
美国约有 10 万人患有镰状细胞病（SCD）。这些人在获得公平医疗方面面临着多重障碍。在布莱根妇女医院，由于住院、查房和团队结构的原因，这些患者的现有健康不平等问题更加严重，这些结构将 SCD 患者分配给多个由血液科医生担任主治医生的医学团队，导致患者的治疗出现延误，并且住院医师在血液学知识方面存在差距。
2021 年 9 月创建了血液科-普通内科混合团队，以提高住院医师管理血液学疾病的知识、技能和信心，并提高向 SCD 患者提供的护理质量。这使得具有典型血液学疾病的患者能够在特定的医院病房中进行区域化管理，这些病房由一个团队负责，该团队由一名血液科医生担任主治医生。
从 2021 年 10 月 1 日至 2022 年 1 月 11 日，患有主要血液学诊断的患者中有 745/824（90%）的住院天数由血液科-普通内科混合团队负责。在这 824 个住院日中，有 331 个（40%）被转到混合团队的家庭病房，与其他团队的区域化率一致。从 2021 年 10 月 1 日至 2022 年 9 月 30 日，共有 128 名患有 SCD 的独特患者在 511 次就诊中接受了治疗，由大约 78 名住院医师和 12 名医学生负责。住院医师的反馈报告称，他们在血液学疾病管理方面的知识得到了提高，特别是在 SCD 方面。
作者正在对混合团队对住院医师管理 SCD 的技能和信心的影响进行全面分析。作者认为，即使血液科医生只是顾问而不是主治医生，这种模式也可以在其他机构复制，以优化住院医师教育、整合护理并解决对 SCD 患者的隐性偏见。
