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每日出院文件记录可改善患者流程和出院效率。

Daily Dispo Documentation Improves Patient Flow and Discharge Efficiency.

作者信息

Bechir George

机构信息

Hospital Medicine, Franciscan Health Munster, Munster, USA.

出版信息

Cureus. 2025 Jul 26;17(7):e88814. doi: 10.7759/cureus.88814. eCollection 2025 Jul.

Abstract

"Dispo," short for disposition, refers to the anticipated plan for a hospitalized patient's discharge, including timing and destination. Reducing hospital length of stay requires more than discharge orders and case management rounds. It demands daily, structured planning embedded in the clinical workflow. This review explores the underused yet high-impact strategy of "daily dispo documentation," in which hospitalists explicitly document five key discharge planning elements in each progress note. This framework has been adopted by some institutions to improve discharge efficiency. These elements are expected discharge date, consultant communication, patient and family communication, reason for not discharging today, and planned discharge destination. Each element plays a distinct and actionable role. Setting and updating the expected discharge date creates a shared mental target that drives task completion and team alignment. Capturing consultant communication ensures clarity and resolution of pending recommendations, a common source of delays. Documenting patient and family discussions strengthens readiness and engagement, reducing confusion and post-discharge errors. Recording the reason for not discharging today transforms the note into a daily operational audit by making barriers visible and prompting immediate problem-solving. Finally, stating the planned discharge destination early allows social work and case management to arrange placements proactively, reducing failures on the day of discharge. Framed within established models such as IDEAL (initiating, diagnosing, establishing, acting, and learning), which involves patients and families in discharge planning, SAFER, a set of steps to improve patient flow, and Red2Green, which minimizes unnecessary hospital days, this approach shifts documentation from passive recordkeeping to active discharge coordination. Hospitals that implement daily dispo notes have demonstrated reductions in length of stay, smoother care transitions, improved patient satisfaction, and operational and financial benefits. As healthcare systems aim to improve efficiency while maintaining safety and patient-centered care, embedding dispo elements into the daily note offers a scalable and evidence-based solution rooted in frontline workflow.

摘要

“出院计划”(Dispo,即处置的缩写)指的是针对住院患者出院的预期计划,包括出院时间和目的地。缩短住院时间所需的不仅仅是出院医嘱和病例管理查房。它需要在临床工作流程中进行每日的结构化规划。本综述探讨了“每日出院计划记录”这一未得到充分利用但影响重大的策略,即住院医师在每份病程记录中明确记录五个关键的出院计划要素。一些机构已采用这一框架来提高出院效率。这些要素包括预期出院日期、与会诊医生的沟通、与患者及家属的沟通、今日不出院的原因以及计划出院目的地。每个要素都发挥着独特且可操作的作用。设定并更新预期出院日期可创建一个共同的心理目标,推动任务完成并使团队保持一致。记录与会诊医生的沟通可确保待办建议清晰明了并得到解决,这是导致延迟的常见原因。记录与患者及家属的讨论可增强准备程度和参与度,减少混乱和出院后错误。记录今日不出院的原因可通过使障碍显而易见并促使立即解决问题,将病程记录转变为每日运营审计。最后,尽早说明计划出院目的地可使社会工作和病例管理部门提前安排安置事宜,减少出院当天的失误。在诸如IDEAL(启动、诊断、制定、行动和学习,该模型让患者和家属参与出院计划)、SAFER(一套改善患者流程的步骤)以及Red2Green(将不必要的住院天数降至最低)等既定模式的框架内,这种方法将记录从被动的记录保存转变为积极的出院协调。实施每日出院计划记录的医院已证明住院时间缩短、护理过渡更顺畅、患者满意度提高以及运营和财务效益提升。随着医疗系统旨在提高效率同时保持安全和以患者为中心的护理,将出院计划要素纳入每日病程记录提供了一种基于一线工作流程的可扩展且有循证依据的解决方案。

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