A multidisciplinary approach to decreasing length of stay in acute care surgery patients. (26th March 2020) - DePesa, Christopher D.
Abstract: 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 Abstract : 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