Discharge before noon: Effect on throughput and sustainability
Discharge before noon: Effect on throughput and sustainability
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DOI：
10.1002/jhm.2412
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发表时间：
2015-10-01
影响因子：
2.6
通讯作者：
Hochman, Katherine
中科院分区：
文献类型：
--
作者：
Wertheimer, Benjamin;Jacobs, Ramon E. A.;Hochman, Katherine
下午晚些时候出院被认为是造成入院瓶颈的原因。我们先前描述了一种干预措施，导致2个住院医疗单位的中午前出院（DBN）率在统计学上显著增加。为了评估（1）DBN率增加对入院到达时间和每小时入院人数的影响，以及（2）我们的DBN倡议的可持续性。在三级医疗、城市、学术医疗中心护理住院医疗单位。病人：对于入院到达时间和每小时入院人数的分析，所有住院患者均在2011年6月1日至2013年6月31日期间入住医疗单位。对于可持续性分析，所有患者均于2013年7月1日至2014年12月31日出院。INTERVENTIONA多学科干预以提高DBN率。测量：到达所有住院地点的日期和时间，以及所有患者从2个住院医疗单位出院的日期和时间。在我们提高DBN率的同时，我们发现急诊科（艾德）入院和转院的中位到达时间从下午5点到下午4点发生了统计学显著变化。对于艾德入院，高频入院高峰在统计学上显著降低。DBN率的统计学显著性增加持续在35%.CONCLUSION增加DBN率与入院在一天中到达较早和艾德入院的高频峰值的减少相关。DBN率在统计上的显著改善是可持续的。医院医学杂志2015;10：664-669。(c)2015年医院医学学会
BACKGROUNDLate afternoon hospital discharges are thought to contribute to admission bottlenecks. We previously described an intervention that resulted in a statistically significant increase in the discharge before noon (DBN) rate on 2 inpatient medicine units.OBJECTIVETo evaluate (1) the effect of an increased DBN rate on the admission arrival time and the number of admissions per hour and (2) the sustainability of our DBN initiative.DESIGNPre-/postintervention retrospective analysis.SETTINGTwo acute-care inpatient medicine units in a tertiary care, urban, academic medical center. PATIENTS: For the admission arrival time and admissions per hour analysis, all inpatients admitted to the medical units from June 1, 2011 to June 31, 2013. For the sustainability analysis, all patients discharged from July 1, 2013 to December 31, 2014.INTERVENTIONA multidisciplinary intervention to increase the DBN rate. MEASUREMENTS: Date and time of arrival to all inpatient sites, and discharge date and time of all patients from 2 inpatient medicine units.RESULTSConcurrent with our increase in DBN rate, we found a statistically significant change in the median arrival time of emergency department (ED) admissions and transfers from 5 pm to 4 pm. High-frequency admission peaks were statistically significantly reduced for ED admissions. The statistically significant increase in DBN rate is sustained at 35%.CONCLUSIONSIncreasing the DBN rate correlates with admissions arriving earlier in the day and reductions in high-frequency peaks of ED admissions. Statistically significant improvements in DBN rates are sustainable. Journal of Hospital Medicine 2015;10:664-669. (c) 2015 Society of Hospital Medicine