Post-call transfer of resident responsibility
Post-call transfer of resident responsibility
复制标题
居民责任的呼叫后转移
DOI：
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发表时间：
1990
影响因子：
5.7
通讯作者：
E. Rich
中科院分区：
文献类型：
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作者：
R. Lofgren;D. Gottlieb;Raegan Williams;E. Rich
目的：为了确定是否转移照顾病人的另一个高级居民入院后的第二天bospital不利影响的效率和质量的照顾。设计：回顾性分析的自然实验。设置：一般医疗服务的明尼阿波利斯退伍军人事务医疗中心，一个主要的第三教学医院的明尼苏达大学内科住院医师计划。患者/参与者：受试者都是病人入院的医疗服务，从下午5：00至上午6：00超过八个月的时间。干预：5：00后：00下午，一半的病人被一个交叉覆盖的高级住院医生送进医院（CC组患者），并在第二天将其护理转移到不同的高级住院医师。其他患者最初由主要高级住院医师（PE组患者）进行评估。分配到不同的服务是一个随机的，顺序process. Measures和主要结果：CC组有显着更多的实验室检查进行在他们的住院期间比PE组的患者（44比32，p=0.01），即使调整住院时间。使用多元线性回归调整其他临床参数，包括住院时间，DRG重量和咨询次数，作者发现CC受试者是获得实验室检查次数的重要预测因素（p=0.01）。此外，在CC组（n=74）的平均住院时间长于在PE组（n=72）（8天与6天），这是边界的统计学意义，使用双样本中位数检验（p=0.06）。结论：患者转移到不同的居民入院后的第二天进行更多的实验室检查和更长的住院时间。
Objective:To determine whether transferring the care of patients to another senior resident the day after admission to the bospital adversely affects the efficiency and quality of care.Design:Retrospective analysis of a natural experiment.Setting:The general medical service of the Minneapolis Veterans Affairs Medical Center, a major tertiary teaching hospital of the University of Minnesota internal medicine residency program.Patients/participants:Subjects were all the patients admitted to the medicine service from 5:00 PM to 6:00 AM over an eight-month period.Intervention:After 5:00 PM, half of the patients were admitted to the hospital by a cross-covering senior resident (CC group of patients), and their care was transferred to a different senior resident the following day. The other patients were initially evaluated by the primary senior resident (PE group of patients). Assignment to the different services was a random, sequential process.Measurements and main results:The CC group had significantly more laboratory tests performed during their hospital stay than did the PE group of patients (44 vs. 32, p=0.01), even when adjusted for length of stay. Using multiple linear regression to adjust for other clinical parameters including length of stay, DRG weight, and number of consults, the authors found that being a CC subject was a significant predictor of the number of laboratory tests obtained (p=0.01). Furthermore, the median length of stay in the CC group (n=74) was longer than that in the PE group (n=72) (eight days vs. six days); this was of borderline statistical significance, using a two-sample median test (p=0.06).Conclusion:Patients transferred to a different resident the day after admission had more laboratory tests performed and longer inpatient stays.