How much do operational processes affect hospital inpatient discharge rates?
How much do operational processes affect hospital inpatient discharge rates?
复制标题
运营流程对医院住院患者出院率有多大影响？
作者：
H. Wong;R. Wu;G. Tomlinson;Michael Caesar;H. Abrams;M. W. Carter;Dante Morra
背景
这项研究的目的是确定一周中的哪一天、假期、团队入院和轮换时间表、个别主治医生及其覆盖时间长短对每日团队退职率的影响。
方法
我们对本机构2005年和2006年的全科内科(GIM)住院服务进行了回顾分析，其中包括5088名在GIM护理下的患者。
结果
与参考利率相比，周末出血率下降了50%以上，而周五的出血率上升了24%。节假日星期一的排泄率比正常的星期一低65%，节前的排泄率有所增加。与对照相比，待命或第二天待命的团队的出院比例高出15%，而呼叫后的团队的出院比例低20%。个别主治医生和主治医生的覆盖时间对出院率的影响很小。住院时间安排对出院率没有显著的预测作用。
结论
一周中的某一天和节假日以及随后的团队组织和日程安排是排泄率每日变化的重要预测因素。引入更大的假期和周末运力，以及重组内部流程，如入院和参加时间表，可能会优化排泄率。
BACKGROUND
The objective of this study is to determine the effect of day of the week, holiday, team admission and rotation schedules, individual attending physicians and their length of coverage on daily team discharge rates.
METHODS
We conducted a retrospective analysis of the General Internal Medicine (GIM) inpatient service at our institution for years 2005 and 2006, which included 5088 patients under GIM care.
RESULTS
Weekend discharge rate was more than 50% lower compared with reference rates whereas Friday rates were 24% higher. Holiday Monday discharge rates were 65% lower than regular Mondays, with an increase in pre-holiday discharge rates. Teams that were on-call or that were on call the next day had 15% higher discharge rates compared with reference whereas teams that were post-call had 20% lower rates. Individual attending physicians and length of attending coverage contributed small variations in discharge rates. Resident scheduling was not a significant predictor of discharge rates.
CONCLUSIONS
Day of the week and holidays followed by team organization and scheduling are significant predictors of daily variation in discharge rates. Introducing greater holiday and weekend capacity as well as reorganizing internal processes such as admitting and attending schedules may potentially optimize discharge rates.