Levetan C S, Salas J R, Wilets I F, Zumoff B
Department of General Internal Medicine, Washington Hospital Center, Washington, DC 20010, USA.
Am J Med. 1995 Jul;99(1):22-8. doi: 10.1016/s0002-9343(99)80100-4.
To determine whether consultation by an individual endocrinologist or by a multidisciplinary diabetes team (endocrinologist, diabetes nurse educator, and registered dietitian) can impact length of hospital stay of patients with diabetes.
Hospital stays of consecutive patients with a principal diagnosis of diabetes were compared. Forty-three patients were seen by an individual endocrine consultant and 27 were managed by the internist alone. Thirty-four patients were seen in consultation by the diabetes team. All consultations were performed at the request of the primary physician. There were no statistically significant differences among groups with respect to age, duration of diabetes, admitting diagnosis, glucose levels, or concomitant acute or chronic illness.
Average length of stay of diabetes-team patients was 3.6 +/- 1.7 days, 56% shorter than the value, 8.2 +/- 6.2 days, of patients in the no-consultation group (P < 0.0001), and 35% shorter than the value, 5.5 +/- 3.4 days, of patients who received a traditional individual endocrine consultation (P < 0.05). The length of stay correlated with time from admission to consultation (regression equation: y = 3.92 + [1.09 x time to consultation]; r = .55; P < 0.0001). The slope (1.09) indicates that each 1-day delay in consultation resulted in a 1-day increase in length of stay.
Length of stay was lowest in patients who received diabetes-team consultation. Three million Americans are hospitalized annually with diabetes at a cost of $65 billion. A team approach to their inpatient care may reduce their hospital stays, resulting in considerable health and economic benefits.
确定由内分泌科医生个人或多学科糖尿病团队（内分泌科医生、糖尿病护士教育者和注册营养师）进行会诊是否会影响糖尿病患者的住院时间。
比较了主要诊断为糖尿病的连续患者的住院情况。43名患者由内分泌科顾问进行会诊，27名患者仅由内科医生管理。34名患者由糖尿病团队会诊。所有会诊均应主治医师的要求进行。各组在年龄、糖尿病病程、入院诊断、血糖水平或伴发的急性或慢性疾病方面无统计学显著差异。
糖尿病团队会诊患者的平均住院时间为3.6±1.7天，比未会诊组患者的8.2±6.2天短56%（P<0.0001），比接受传统内分泌科医生个人会诊的患者的5.5±3.4天短35%（P<0.05）。住院时间与从入院到会诊的时间相关（回归方程：y = 3.92 + [1.09×会诊时间]；r = 0.55；P<0.0001）。斜率（1.09）表明会诊每延迟1天，住院时间就增加1天。
接受糖尿病团队会诊的患者住院时间最短。每年有300万美国人因糖尿病住院，费用达650亿美元。采用团队方法进行住院治疗可能会缩短他们的住院时间，从而带来可观的健康和经济效益。
