Evaluation of a Staff-Only Hospitalist System in a Tertiary Care, Academic Children's Hospital
Evaluation of a Staff-Only Hospitalist System in a Tertiary Care, Academic Children's Hospital
复制标题
对三级护理、学术儿童医院纯职员住院系统的评估
作者：
P. Dwight;C. Macarthur;J. Friedman;P. Parkin
目标。工作人员/家庭工作人员住院医生制度已经在美国的两个儿科中心进行了评估。在加拿大，更少的居民和值班时间限制导致了仅限工作人员住院的制度的发展。这项研究的目的是比较仅由工作人员组成的儿科住院医生制度和工作人员/家庭工作人员住院医生制度与传统结果衡量标准的差异。设计。这项队列研究(仅限工作人员住院医生系统与工作人员/家庭工作人员系统)使用电子健康记录数据(1996年7月1日至1997年6月30日)，针对加拿大多伦多一家城市、三级保健、儿科和教学医院的普通儿科住院病房(n=3807)。结果测量包括住院时间、专科会诊、再次入院和住院期间死亡。结果。与工作人员/家务工作人员住院医生制度(分别为2.5天和2.9天)相比，进入仅限工作人员住院医生制度的患者的住院时间中位数减少了14%。在调整了年龄、性别和合并症后，这一差异在统计学上仍然显著。在专科会诊、再次住院或死亡率方面，两种护理模式之间没有显著差异。一项分层分析显示，10个最常见的诊断组也有类似的发现。结论。与工作人员/住院医生制度相比，仅由工作人员组成的住院医生制度大大缩短了住院时间，没有对死亡率或再住院率产生不利影响的证据。在美国最近对住院值班时间的限制的背景下，这些发现可能会对儿科教学医院考虑开发类似的仅限工作人员住院的模式感兴趣。
Objective. The staff/housestaff hospitalist system has been evaluated in 2 pediatric centers in the United States. In Canada, fewer residents and duty hour restrictions led to the development of a staff-only hospitalist system. The objective of this study was to compare the staff-only pediatric hospitalist system and the staff/housestaff hospitalist system with respect to traditional outcome measures. Design. This cohort study (staff-only hospitalist system versus staff/housestaff system) used electronic health records data (July 1, 1996, to June 30, 1997) for all admissions (n = 3807) to the general pediatric inpatient unit of an urban, tertiary care, pediatric, teaching hospital in Toronto, Canada. Outcome measures included length of hospital stay, subspecialty consultations, readmission to the hospital, and death during the hospital stay. Results. The median length of hospital stay was reduced by 14% for patients admitted to the staff-only hospitalist system, compared with the staff/housestaff hospitalist system (2.5 and 2.9 days, respectively). This difference remained statistically significant after adjustment for age, gender, and comorbidity. There were no significant differences between the 2 models of care with respect to subspecialty consultation, hospital readmission, or mortality rates. A stratified analysis showed similar findings for the 10 most frequent diagnostic groups. Conclusions. The staff-only hospitalist system was associated with a significant reduction in the hospital length of stay, without evidence of adverse effects on mortality or readmission rates, compared with the staff/hospitalist system. In the context of recent restrictions on resident duty hours in the United States, these findings may be of interest to pediatric teaching hospitals considering the development of a similar staff-only hospitalist model.
健康维护组织住院医师系统对学术儿科的影响。
影响因子：
8
作者：
Landrigan,ChristopherP;Srivastava,Rajendu;Muret-Wagstaff,Sharon;Soumerai,StephenB;Ross-Degnan,Dennis;Graef,JohnW;Homer,CharlesJ;Goldmann,DonaldA
通讯作者：
Goldmann,DonaldA