Inpatient Provider Rounding Prioritazation of Patients Ready for Discharge

住院医疗服务提供者对准备出院的患者进行四舍五入优先排序

• 批准号: 10056109
• 负责人: Marisha Burden
• 金额: $ 10万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2022-03-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10056109
• 关键词: Inpatient; Provider; Rounding; Prioritazation; Patients

Project Summary/Abstract Hospitals around the country face bottlenecks and capacity issues. When hospitals are successful at managing high capacity this allows for increased access for patients who need this higher level of care and expertise. Unfortunately, hospital discharges frequently occur in the afternoon or evening hours and can adversely affect patient flow throughout the hospital which, in turn, can result in delays in care, medication errors, increased mortality, longer lengths of stay, higher costs, lower patient satisfaction, and decreased access to care at these facilities. While some of the delays in discharges result, appropriately, from the caring of other patients and conducting the necessary tasks and assessments for acutely ill patients, our previous work also identified that providers may be able to prioritize their work in a different way in order to facilitate this throughput. We aim to conduct a randomized controlled trial of physician rounding style at three institutions in order to: (1) determine if prioritizing discharging patients first will result in earlier discharges and decreased lengths of stay, (2) determine if prioritizing discharges first will cause other care delays or affect patient experience and, (3) determine factors that contribute to physician ability to prioritizing discharges first. The proposed study is a prospective, multi-center, cluster randomized trial designed to test the effects of rounding on discharging patients first compared to usual practice and will utilize an effectiveness-implementation hybrid approach. We will recruit hospitalist attending physicians from three hospitals in the US to be randomized to one of two rounding styles: (1) prioritize discharges first and (2) usual practice. The main outcome measure will be discharge order time. Secondary outcomes will be length of stay, lab/diagnostic test order time, and patient experience as measured through the HCAHPS survey. Additionally, we will study how team composition (teaching, non-teaching, teams with advanced practice providers), team census (i.e. the number of patients a provider is caring for), and number of admissions affect the ability for providers to prioritize discharges first. Through qualitative methods we will also gain an understanding from physicians as to why or why not they were able to prioritize discharges first. This study will add to the evidence to either support or negate the practice of prioritizing discharges. There have been no randomized studies to date that have addressed these issues. Additionally, we aim to understand how team composition and census affect discharge times. Institutions across the country will be able to utilize these findings to help refine current rounding models. We believe these findings will be pivotal for clinicians to be more willing to change their practice style. We also believe this study will aid in the understanding of what factors may function as facilitators and barriers of earlier discharges.

项目摘要/摘要 全国各地的医院都面临着瓶颈和容量问题。当医院在管理方面取得成功 高容量这使需要这种更高水平护理和专业知识的患者能够更多地获得治疗。 不幸的是，医院出院经常发生在下午或晚上，可能会对 病人在医院内流动，进而可能导致护理延误、用药失误、增加 死亡率、更长的住院时间、更高的费用、更低的患者满意度以及在这些地方获得护理的机会减少 设施。虽然一些出院延迟是由于照顾其他患者和 在对危重患者进行必要的任务和评估时，我们之前的工作也发现 提供商可能能够以不同的方式确定其工作的优先顺序，以促进此吞吐量。我们的目标是 在三个机构进行医生查房方式的随机对照试验，以：(1)确定是否 优先安排出院患者的优先顺序将导致更早的出院时间和减少的住院时间，(2)确定 优先出院是否会导致其他护理延误或影响患者体验，以及，(3)确定因素 这有助于医生优先处理出院。 建议的研究是一项前瞻性、多中心、整群随机试验，旨在测试舍入的效果 与通常做法相比，首先出院的患者将采用有效性-实施混合 接近。我们将从美国三家医院招募住院主治医生，随机分成一组 两种舍入方式：(1)优先排放和(2)惯常做法。主要结果衡量标准将是 出院命令时间。次要结果将包括住院时间、实验室/诊断测试顺序时间和患者 通过HCAHPS调查衡量的经验。此外，我们还将研究团队的组成 (教学、非教学、具有高级实践提供者的团队)、团队普查(即 提供者关心的)，以及入院人数影响提供者首先确定出院优先顺序的能力。 通过定性的方法，我们还将从医生那里了解为什么他们会或为什么不会 能够优先排出货物的优先顺序。 这项研究将增加证据，以支持或否定排污优先的做法。那里 到目前为止，还没有针对这些问题的随机研究。此外，我们的目标是 了解团队组成和人口普查如何影响出院时间。全国各地的机构将是 能够利用这些发现来帮助改进当前的舍入模型。我们相信这些发现将对 临床医生更愿意改变他们的执业方式。我们也相信这项研究将有助于 了解哪些因素可能起到促进和阻碍早期排出的作用。