Acute Medical Unit, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
Acute Medical Unit, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
BMJ Open Qual. 2024 Mar 1;13(1):e002421. doi: 10.1136/bmjoq-2023-002421.
This quality improvement project (QIP) aimed to assess the impact of automating patient list generation on the acute medical unit (AMU) at Sandwell and West Birmingham Hospitals NHS Trust. The AMU patient list categorises patients requiring 'clerking', 'post-take' (PTWR) and 'post-post-take' (PPTWR) for the morning ward round. During weekdays, this list need only include the patients in AMU. For weekends, this list must include 'outliers', that is, patients transferred to different wards (which may lack resident medical teams over the weekends) but still requiring PTWR/PPTWR. The list is created by the junior doctor on their night shift, a daily necessity due to the high AMU patient turnover.A pilot study, followed by three complete 'plan-do-study-act' (PDSA) cycles, was conducted over 2021/2022. Cycle 1 (pre-intervention) and cycle 2 (post-intervention) assessed the impact of the generator on weekdays. This was adapted for the weekend over cycles 2 and 3. The process measure assessed was the time taken for list generation. The outcome measure was the total number of patients clerked per night. The balancing measure was doctors' attitudes.The intervention reduced the time taken for list generation by an average of 44.3 min (66.3%) during weekdays and 37.8 min (42%) during weekends. Run charts demonstrated significance for the reduction in weekday list generation time. Both weekdays (63.5% decrease, p<0.00001) and weekends (50.5% decrease, p=0.0007) had significant reductions in total negative attitudes. Both weekdays and weekends had 'time-consuming' as the most frequently selected attitude pre-intervention, whereas 'easy to make' was most frequently selected post-intervention. Some junior doctors reported the generator enabled clerking of extra patients, supported by non-significant increases in the averages for this outcome.This QIP demonstrates how the automation of labour-intensive administrative tasks results in notable time-saving outcomes. Thereby improving doctor attitudes and well-being, and facilitating the delivery of quality patient care.
本质量改进项目（QIP）旨在评估在桑德韦尔和西米德兰兹大学医院 NHS 信托的急症医学部（AMU）自动化患者列表生成对其产生的影响。AMU 患者列表将需要进行“ clerks ”、“ post-take ”（PTWR）和“ post-post-take ”（PPTWR）的患者进行分类，以便进行晨间查房。在工作日，该列表仅需包含 AMU 的患者。对于周末，该列表必须包含“异常值”，即转移到不同病房的患者（这些病房可能在周末缺乏常驻医疗团队），但仍需要进行 PTWR/PPTWR。该列表由夜班医生创建，这是由于 AMU 患者周转率高，因此是日常必要操作。2021/2022 年期间进行了一项试点研究，随后进行了三个完整的“计划-执行-研究-行动”（PDSA）循环。第 1 周期（干预前）和第 2 周期（干预后）评估了生成器对工作日的影响。在第 2 周期和第 3 周期，该影响进行了周末的适应性调整。过程衡量标准是生成列表所需的时间。结果衡量标准是每夜接受检查的患者总数。平衡衡量标准是医生的态度。干预措施将生成列表的时间平均缩短了 44.3 分钟（66.3%），在周末则缩短了 37.8 分钟（42%）。运行图显示出工作日列表生成时间减少具有统计学意义。工作日（减少 63.5%，p<0.00001）和周末（减少 50.5%，p=0.0007）的总消极态度均显著减少。在干预前，“耗时”是最常被选择的态度，而干预后“容易制作”是最常被选择的态度。一些初级医生报告称，该生成器使他们能够为更多的患者进行检查，这一结果支持了这一发现，该结果的平均值也有所增加，但没有统计学意义。本 QIP 证明了如何通过自动化劳动密集型行政任务来实现显著的节省时间的成果。从而改善医生的态度和幸福感，并促进提供高质量的患者护理。
