Hospitalist care and length of stay in patients requiring complex discharge planning and close clinical monitoring
Hospitalist care and length of stay in patients requiring complex discharge planning and close clinical monitoring
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DOI：
10.1001/archinte.167.17.1869
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发表时间：
2007-09-24
影响因子：
--
通讯作者：
Arnsten, Julia H.
中科院分区：
文献类型：
--
作者：
Southern, William N.;Berger, Matthew A.;Arnsten, Julia H.
背景：学术医疗中心越来越多地雇用住院医师来为教学病房配备人员。虽然研究表明住院治疗可缩短住院时间（LOS），但尚不清楚哪些患者最有可能受益。我们试图确定是否有具体的诊断或出院需求的病人帐户住院治疗和减少LOS.Methods之间的关联：住院被分为以下2组的基础上类型的主治医师：教学住院医师（全职教师住院医师没有门诊责任）与nonhospitalist（全职或自愿教师每年贡献1或2个月的教学服务）。我们纳入了所有从学术教学服务中出院的患者，为期2年。结果：教学住院医师的平均住院时间低于非住院医师（5.01天vs 5.87天[P <0.01]），教学住院医师的平均住院时间低于非住院医师（5.01天vs 5.87天[P <0.01]）。02]）。对于需要密切临床监测的患者（充血性心力衰竭、中风、哮喘或肺炎患者）和需要复杂出院计划的患者，LOS降低最大。两组在再入院率、住院死亡率或30天死亡率方面无显著差异。结论：教学住院医师护理与需要密切临床监测和复杂出院计划的患者的LOS较短相关，而不会对再入院率或死亡率产生不良影响。
Background: Academic medical centers are increasingly employing hospitalists to staff teaching wards. Although studies have demonstrated reduced lengths of stay (LOSs) associated with hospitalist care, it is unclear which patients are most likely to benefit. We sought to determine whether patients with specific diagnoses or discharge needs account for the association between hospitalist care and reduced LOS.Methods: Hospital admissions were divided into the following 2 groups based on type of attending physician: teaching hospitalist (full-time faculty hospitalist with no outpatient responsibilities) vs nonhospitalist (full-time or voluntary faculty contributing 1 or 2 months of teaching service per year). We included all patients discharged from an academic teaching service for a 2-year period. Data were extracted from the Montefiore Medical Center's clinical information system and the Social Security Death Registry.Results: Mean LOS was lower for teaching hospitalists than for nonhospitalists (5.01 vs 5.87 days [P < . 02]). The reduction in LOS was greatest for patients requiring close clinical monitoring (patients with congestive heart failure, stroke, asthma, or pneumonia) and for those requiring complex discharge planning. There were no significant differences between the groups in readmission, in-hospital mortality, or 30-day mortality.Conclusion: Teaching hospitalist care was associated with shorter LOS in patients requiring close clinical monitoring and complex discharge planning, without adversely affecting readmission or mortality rates.