A firm trial of interdisciplinary rounds on the inpatient medical wards - An intervention designed using continuous quality improvement
A firm trial of interdisciplinary rounds on the inpatient medical wards - An intervention designed using continuous quality improvement
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DOI：
10.1097/00005650-199808001-00002
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发表时间：
1998-08-01
期刊：
影响因子：
3
通讯作者：
Speroff, T
中科院分区：
文献类型：
--
作者：
Curley, C;McEachern, JE;Speroff, T
目标. 1993年8月，MetroHealth医疗中心的一组住院工作人员和护理人员组成了一个质量改进小组，以评估住院病房的医疗护理过程。使用标准的持续质量改进（CQI）方法，一个由内科实习生、护士和其他医疗专业人员组成的团队参与内科住院服务中的患者护理，设计了跨学科的日常工作查房，以改善住院病房中患者的护理。作者进行了一项随机对照试验，研究跨学科查房对住院医疗服务的影响。试验持续了6个月（1993年11月至1994年4月），包括1,102名住院患者，由预先存在的公司系统随机分配到实验组或对照组。在纳入研究的1，102名住院患者中，535名被随机分配到传统医疗服务，567名被随机分配到跨学科医疗服务。研究的结果包括住院时间（LOS），总医院费用，供应商的满意度，和辅助服务效率。对数转换数据的未调整分析显示，跨学科组的住院时间和总费用较低。跨学科查房的平均住院时间为5.46天，而传统护理为6.06天（P = 0.006），而两组的平均总费用分别为6,681美元和8,090美元（P = 0.002）。多变量回归分析后，使用倾向评分，包括性别，年龄，婚姻状况，入院来源，诊断相关组（DRG）体重，和国际疾病分类第九修订版（ICD-9）聚类的初步诊断，这些差异仍然具有统计学意义。以前对跨学科团队的研究未能显示出统计上显着的成本节约。这项涉及更多患者的研究表明，使用跨学科团队可以降低成本和LOS。在为期6个月的试验结束时，所有内科住院服务都建立了跨学科查房。
OBJECTIVES. In August 1993 a group of house staff and nursing staff at MetroHealth Medical Center formed a quality improvement team to evaluate the process of medical care on the inpatient wards. Using standard continuous quality improvement (CQI) methods, a team of medical interns, nurses, and other health professionals involved in patient care on the medicine inpatient service designed interdisciplinary, daily work rounds to improve the care of patients on the inpatient wards.METHODS. The authors conducted a randomized, controlled firm trial of the impact of interdisciplinary rounds on the inpatient medicine services. The trial lasted 6 months (November 1993-April 1994) and included 1,102 admissions randomly assigned to experimental or control teams by the pre-existing firm system. Of the 1,102 admissions included in the study, 535 were randomized to medical services with traditional rounds and 567 to medical services with interdisciplinary rounds. The outcomes studied included length of stay (LOS), total hospital charges, provider satisfaction, and ancillary service efficiency.RESULTS. Unadjusted analysis for log-transformed data showed lower length of stay and total charges for the interdisciplinary group. The mean LOS for interdisciplinary rounds was 5.46 days, compared with 6.06 days for traditional care (P = 0.006), whereas mean total charges were $6,681 and $8,090 (P = 0.002) for the two groups, respectively. After multivariate regression analysis using a propensity score that included gender, age, marital status, admission source, diagnosis-related group (DRG) weight, and primary diagnosis by International Classification of Diseases, Ninth Revision (ICD-9) cluster, these differences remained statistically significant.CONCLUSIONS. Previous studies of interdisciplinary teams have failed to show statistically significant cost savings. This study involving more patients shows both cost and LOS decreases with the use of interdisciplinary teams. At the end of the 6-month trial, interdisciplinary rounds were instituted on all medicine inpatient services.