Aim: To decrease hospital length of stay in acute care surgery patients.
Design: An observational cohort quality improvement project at a single tertiary referral centre.
Methods: A multidisciplinary team of physicians, nurses, case managers, and physical and occupational therapists was created to identify patients at risk for prolonged length of stay and implement weekly multidisciplinary rounding, with a systematic method of tracking progress in real time. The main outcome measure was hospital length of stay. The observed/expected ratios for length of stay 2 years before (2012-2014) and after (2014-2016) the intervention were compared.
Results: A total of 6,120 patients was analysed. Early identification and action on barriers to discharge created a significant decrease in risk-adjusted acute care surgery patient days per year (96 days) with limited added cost (1-2 hr per week). Patients discharged to home with or without services benefited most.
Conclusion: Decreasing length of stay in acute care surgery patients is possible without adding a significant burden to healthcare providers.
Impact: We describe a comprehensive, multidisciplinary initiative to decrease the length of stay of acute care surgery patients. Institutions can use existing resources in a sustainable manner to create a significant decrease in patient days per year with limited added cost. REGISTRATION: https://osf.io/zfc3t.
目的: 缩短急症护理手术病人的住院时间。 设计: 在一个三级转诊中心开展观察性队列质量改进项目。 方法: 组建了一支由医师、护士、病例管理人员、理疗师和职业治疗师组成的多学科团队,以识别有住院时间延长风险的患者,并开展每周多学科凑整,同时采用系统的方法实时跟踪进展。主要评价指标为住院时间。对干预前(2012年-2014年)和干预后(2014年-2016年)两年内住院时间的观察/预期比率进行比较。 结果: 共对6,120名病人进行了分析。早期确定出院阻碍因素并采取行动,使风险调整后的急症护理手术病人每年的住院天数(96天)显著减少,而且增加的成本有限(每周1-2小时)。出院回家的病人无论是否接受医疗服务均受益最多。 结论: 在不显著增加医疗服务提供者负担的情况下,有可能实现缩短急症护理手术病人的住院时间。 影响: 我们描述了一个全面的多学科倡议,以缩短急症护理手术病人的住院时间。机构可凭借可持续的方式利用现有资源,在有限的附加成本下,显著减少病人每年的住院天数。 注册: https://osf.io/zfc3t.
Keywords: acute care surgery; health resources; length of stay; multidisciplinary; nurse; nursing; quality improvement.
© 2020 John Wiley & Sons Ltd.