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出院查房对患者流程及医院结局的影响。

Impact of Discharge Rounds on Patient Flow and Hospital Outcomes.

作者信息

Bechir George, Anja Mishame

机构信息

Hospital Medicine, Franciscan Health, Munster, USA.

Medicine, Black Lion Specialized Hospital, Addis Ababa, ETH.

出版信息

Cureus. 2025 Sep 14;17(9):e92267. doi: 10.7759/cureus.92267. eCollection 2025 Sep.

DOI:10.7759/cureus.92267
PMID:40955335
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12433610/
Abstract

Discharge delays are a common and costly problem in hospitals, exposing patients to preventable risks while straining system capacity. Discharge rounds are structured daily meetings designed to identify barriers and coordinate care, and have emerged as a potential solution, yet implementation varies widely across institutions. This narrative review examined 38 studies published between 2010 and 2024 that evaluated discharge rounds in adult acute care hospitals. The evidence demonstrated that outcomes depend more on execution than on the concept itself. Hybrid formats that combine in-person and virtual participation improved attendance and preserved communication quality. Early morning rounds of limited duration facilitated timely discharges and aligned better with hospital operations. A lean but interdisciplinary core team of hospitalists, case managers, and nurses was consistently effective, with pharmacists and social workers adding value in select populations. Nursing participation models required tailoring. Bedside nurse involvement proved beneficial in high-acuity settings, while charge nurse representation was effective in more stable units. Geographic cohorting of physicians reduced inefficiency from multi-floor coverage, although handoffs raised continuity concerns. Across all models, the most successful rounds focused their discussion on discharge readiness, specific barriers, assigned responsibilities, and clear timelines rather than broad clinical debates. Programs that lacked structure or drifted from this focus often failed to achieve measurable benefits. In conclusion, discharge rounds can reduce length of stay and improve hospital efficiency, but only when carefully designed. Hospitals seeking to implement or refine discharge rounds should prioritize format, timing, team composition, and discussion focus while adapting to local context.

摘要

出院延迟是医院中常见且代价高昂的问题,使患者面临可预防的风险,同时给系统容量带来压力。出院查房是为识别障碍和协调护理而安排的日常会议,已成为一种潜在的解决方案,但各机构的实施情况差异很大。这篇叙述性综述考察了2010年至2024年间发表的38项评估成人急性护理医院出院查房的研究。证据表明,结果更多地取决于执行情况而非概念本身。结合面对面和虚拟参与的混合形式提高了参与度并保持了沟通质量。持续时间有限的清晨查房促进了及时出院,并且与医院运营更协调。由住院医师、病例管理人员和护士组成的精简但跨学科的核心团队始终有效,药剂师和社会工作者在特定人群中增加了价值。护理参与模式需要量身定制。床边护士参与在高急症环境中被证明是有益的,而护士长代表在更稳定的科室中很有效。医生的地理分组减少了多层覆盖带来的低效率,尽管交接引发了连续性问题。在所有模式中,最成功的查房将讨论重点放在出院准备情况、具体障碍、分配的职责和明确的时间表上,而不是广泛的临床辩论。缺乏结构或偏离这一重点的项目往往未能取得可衡量的效益。总之,出院查房可以缩短住院时间并提高医院效率,但前提是要精心设计。寻求实施或完善出院查房的医院应在适应当地情况的同时,优先考虑形式、时间、团队组成和讨论重点。

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本文引用的文献

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Impact of geographical cohorting, multidisciplinary rounding and incremental case management support on hospital length of stay and readmission rates: a propensity weighted analysis.地理分组、多学科查房和增量病例管理支持对住院时间和再入院率的影响:倾向评分加权分析。
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