Why are we trying to reduce length of stay? Evaluation of the costs and benefits of reducing time in hospital must start from the objectives that govern change.
Why are we trying to reduce length of stay? Evaluation of the costs and benefits of reducing time in hospital must start from the objectives that govern change.
复制标题
为什么我们要努力缩短停留时间？
DOI：
--
复制
发表时间：
1996
期刊：
影响因子：
--
通讯作者：
A. Clarke
中科院分区：
文献类型：
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作者：
A. Clarke
引言在许多不同的国家，那些负责在医院里照顾病人的人都受到一定程度的政治和管理压力，要求他们尽量缩短住院时间。例如，在联合王国，住院时间是卫生服务指标之一，一些管理人员的绩效工资取决于此。众所周知，入院接受治疗的相同病情的患者可能会经历相当大的住院时间差异。人们还普遍认为，减少住院时间将降低成本，而不会影响患者的治疗效果。这意味着什么？它的基础究竟是什么？不难看出，为什么缩短逗留时间是管理层经常关注的焦点。这一概念是可以理解的;在这方面取得的进展也比较容易衡量。此外，其他选择充满困难。大多数管理者都意识到，他们采取行动，以鼓励在服务的其他改进-例如，通过提高临床效率-可能会被视为企图侵犯临床自由。临床医生有他们自己的理由认为减少住院时间是可取的。关于长期住院的危险，有一个相当可怕的警告传统。住院时间往往被视为卧床休息的同义词。例如，Asher早在1948年就说过：“在毯子的舒适之下，潜伏着许多可怕的危险。一年后，《英国医学杂志》的一篇社论提出了大致相同的观点，1960年，《柳叶刀》的一篇题为《旅馆还是医院？“Stallworthy”斥责伦敦教学医院住院时间的可变性，并指出这意味着吞吐量的减少。从那时起，类似的文章也出现了，最近的一篇报纸文章描述了由于医学界认识到卧床休息“会降低士气，导致失眠和便秘”，住院时间大幅减少。4本综述的目的是描述住院时间的变化（特别是在外科手术方面），沿着目前对这种差异的解释;并审查其与健康结果和费用的关系。特别是，审查考虑了四个问题：* 是什么决定了逗留时间的长短？* 住院时间长短对患者的健康结果有影响吗？* 缩短住院时间真的能省钱吗？* 我们是不是应该缩短住院时间？
Introduction In many different countries, those responsible for the care of patients in hospital are under some degree of political and managerial pressure to keep length of stay to a minimum. In the United Kingdom, for example, length of stay is one of the Health Service indicators on which some managers' performance related pay depends. It is known that patients admitted for treatment with the same condition may experience considerable variation in length of stay. And it is also widely held that reductions of time spent in hospital will reduce costs without compromising patient outcomes. What are the implications of this, and what exactly is the basis for it? It is not difficult to see why reduction in stay is a frequent focus for managerial attention. The concept is an accessible one; and progress in such a reduction can be measured relatively easily. Furthermore, the alternatives are fraught with difficulty. Most managers are aware that action on their part to encourage other improvements in a service-for example, through increasing clinical effectiveness-may be seen as an attempt to infringe clinical freedom. Clinicians have their own reasons for holding the view that it is desirable to reduce time spent in hospital. There is a tradition of rather dire warnings about the dangers of a long stay in hospital. Often length of stay is seen to be synonymous with bed rest. For example, Asher as early as 19481 said, "Beneath the comfort of the blanket there lurk a host of formidable dangers." An editorial in the BMY a year later put forward much the same view, and in 1960 in an article in the Lancet entitled "Hotels or hospitals?" Stallworthy' berated London teaching hospitals for their variability in length of stay and pointed out the reduced throughput that this implied. Similar articles have appeared since that time, and a recent newspaper article described the substantial reduction in time spent in hospital as a result of realisation by the medical profession that bed rest "lowers morale and causes insomnia and constipation".4 The aims of this review are to describe variation in length of hospital stay (particularly in relation to surgical procedures), along with currently available explanations for that variation; and to examine its relation to health outcomes and costs. In particular, the review considers four questions: * What determines length of stay? * Does length of stay make a difference to patients' health outcomes? * Do reductions in length of stay really save money? * Should we be trying to reduce length of stay?
马萨诸塞州和加利福尼亚州六种医疗和外科疾病的住院时间和结果的变化。
DOI：
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发表时间：
1991
期刊：
JAMA : the journal of the American Medical Association
影响因子：
--
作者：
Cleary,PD;Greenfield,S;Mulley,AG;Pauker,SG;Schroeder,SA;Wexler,L;McNeil,BJ
通讯作者：
McNeil,BJ
眼外伤住院费用和住院时间的决定因素。
影响因子：
13.7
作者：
Tielsch,JM;Parver,LM
通讯作者：
Parver,LM