General Medicine Unit, Eastern Health, Melbourne, Victoria, Australia.
Intern Med J. 2024 Aug;54(8):1344-1350. doi: 10.1111/imj.16362. Epub 2024 Mar 11.
Patients requiring admission to the general medicine wards in a public hospital are usually assessed by a medical registrar. This study is based at a metropolitan public hospital in Melbourne where the majority of general medicine patients in the emergency department (ED) are not seen by a consultant physician until they are transferred to the ward.
To assess the impact of general medicine consultant-led ward rounds (CWRs) in the ED on patient length of stay (LOS).
One-month audit was conducted of all patients admitted to general medicine and awaiting transfer to ward from ED at a metropolitan public hospital in Melbourne. A general medicine CWR was then implemented in the ED, followed by another 1-month audit, with the primary outcome being LOS and the secondary outcome being 30-day readmission rate. Additionally, admitting medical registrars were invited to complete a survey before and after the implementation of CWRs to assess satisfaction rate.
Data from electronic medical records were analysed for 162 patients (90 preimplementation group and 72 postimplementation group). The median LOS was 6 days in the preimplementation group and 4 days in the postimplementation group (P = 0.014). There was no significant difference in 30-day readmission rates. Surveys showed admitting medical registrars reported a reduced level of stress and fewer barriers to seeking consultant input following implementation.
A CWR in the ED has led to decreased LOS for general medicine patients and improved satisfaction among junior medical staff.
在公立医院，需要住院的内科患者通常由住院医师进行评估。本研究在墨尔本的一家大都市公立医院进行，该院急诊科的大多数内科患者在转至病房之前都不会由顾问医师诊治。
评估内科顾问主导的急诊科查房（CWR）对患者住院时间（LOS）的影响。
对墨尔本一家大都市公立医院急诊科收治并等待转至病房的所有内科患者进行为期一个月的审核。然后在急诊科实施内科顾问 CWR，再进行另一个月的审核，主要结果是 LOS，次要结果是 30 天再入院率。此外，还邀请负责收治的住院医师在实施 CWR 前后完成一项调查，以评估满意度。
对电子病历中的数据进行了分析，共纳入 162 例患者（实施前组 90 例，实施后组 72 例）。实施前组的中位 LOS 为 6 天，实施后组为 4 天（P=0.014）。30 天再入院率无显著差异。调查显示，负责收治的住院医师报告说，实施 CWR 后，他们的压力水平降低，寻求顾问意见的障碍减少。
在急诊科实施 CWR 可缩短内科患者的 LOS，并提高初级医务人员的满意度。
