A Hospitalist-Led Team to Manage Patient Boarding in the Emergency Department: Impact on Hospital Length of Stay and Cost
A Hospitalist-Led Team to Manage Patient Boarding in the Emergency Department: Impact on Hospital Length of Stay and Cost
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DOI：
10.14423/smj.0000000000001043
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发表时间：
2019-12-01
影响因子：
1.1
通讯作者：
Stefan, Mihaela S.
中科院分区：
文献类型：
--
作者：
Hrycko, Alexander;Tiwari, Vishal;Stefan, Mihaela S.
目的：急诊科（艾德）住院病人在等待床位时进入急诊室是病人流动的瓶颈。我们试图通过由一名住院医师、一名高级执业医师和一名病例经理组成的住院医师领导的团队积极管理寄宿艾德医疗入院，来检查对患者流量的影响和节约成本的潜力。方法：这是一项回顾性分析，在一家大型三级医疗中心实施的质量改进试点干预。我们分析了2016年4月1日至2016年6月30日期间在观察状态下住院的患者。我们计算了干预组和常规护理组患者之间的住院时间（小时）和直接成本的差异，这些患者来自前一年的相似时间段，与所有患者的精确诊断相关组（APR-DRG）和疾病严重程度（SOI）水平相匹配。结果在为期3个月的试点期间，175名观察患者由住院医师团队管理。该组的平均住院时间为26.0小时，而常规护理组为29.7小时。直接成本导致以下结果：干预患者组的平均成本为1452美元（+/-775美元），而干预患者组的平均成本为2524美元（+/-894美元），平均节省1072美元（P < 0.001），估计直接成本节省总额为187，660美元。结论由住院医师领导的团队对艾德寄宿患者进行积极管理是可行的，可以节省住院费用，缩短住院时间。从这个试点的结果导致了一个决定，使艾德住院医师领导的团队在我们的机构永久。对该项目的评估可能有助于其他医院决定是否值得在自己的组织中进行这种干预。
Objectives Admitted patients boarding in the emergency department (ED) while awaiting inpatient beds represent a bottleneck in patient flow. We sought to examine the impact on patient flow and potential for cost savings by an active management of boarded ED medical admissions by a hospitalist-led team, which included a hospitalist, an advanced practitioner, and a case manager. Methods This was a retrospectively conducted analysis of a quality improvement pilot intervention implemented at a large tertiary center. We analyzed patients admitted under observation status between April 1, 2016 and June 30, 2016. We calculated the difference for length of stay (in hours) and direct cost between patients in the intervention group and a usual care group from a similar time period in the prior year matched on the all patients refined-diagnosis related groups (APR-DRG) and severity of illness (SOI) level. Results One hundred seventy-five observation patients were managed by the hospitalist team during the 3-month pilot period. This group had an average hospital stay of 26.0 hours compared with 29.7 hours in the usual care group. Direct costs resulted in the following results: average cost for the intervention patient group $1452 (+/-$775) versus $2524 (+/-$894) group, for an average savings of $1072 (P < 0.001), with a total estimated direct cost savings of $187,660. Conclusions Active management of ED boarding patients by a hospitalist-led team is feasible and can lead to hospital cost savings and decrease in hospital stay. The findings from this pilot resulted in a decision to make the ED hospitalist-led team permanent in our institution. The evaluation of the program may help other hospitals to decide whether this intervention is worth pursuing in their own organization.