Inpatient Provider Rounding Prioritazation of Patients Ready for Discharge

项目总结/摘要 全国各地的医院都面临瓶颈和能力问题。当医院成功地管理 高容量这使得需要这种更高水平的护理和专业知识的患者能够获得更多的服务。 不幸的是，医院经常在下午或晚上出院， 整个医院的患者流动，这反过来又会导致护理延误、用药错误、增加 死亡率，住院时间更长，成本更高，患者满意度更低，在这些医院获得护理的机会减少 设施虽然有些延迟出院的原因是照顾其他病人， 为急性病患者进行必要的任务和评估，我们以前的工作还确定， 提供者能够以不同的方式对他们的工作进行优先级排序，以便促进该吞吐量。我们的目标是 在三个机构进行一项随机对照试验，以确定：（1）是否 优先安排病人出院将导致更早出院和缩短住院时间，（2）确定 如果优先安排出院将导致其他护理延迟或影响患者体验，以及（3）确定因素 这有助于医生优先考虑出院的能力。 本研究是一项前瞻性、多中心、整群随机试验，旨在检验舍入的影响 与通常做法相比， approach.我们将从美国三家医院招募住院主治医师，随机分配到一家医院 两种舍入方式：（1）优先排放和（2）通常的做法。主要的结果指标将是 出院令时间次要结局将是住院时间、实验室/诊断检查顺序时间和患者 通过HCAHPS调查衡量的经验。此外，我们还将研究团队组成如何 （教学，非教学，团队与先进的实践提供者），团队普查（即病人的数量， 提供者正在照顾），并且入院数量影响提供者优先考虑出院的能力。 通过定性的方法，我们也将从医生那里了解他们为什么或为什么不这样做。 能够优先考虑出院。 这项研究将增加证据，以支持或否定优先出院的做法。那里 到目前为止，还没有随机研究来解决这些问题。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 能够利用这些发现来帮助完善目前的舍入模型。我们相信这些发现将是关键的， 临床医生更愿意改变他们的实践方式。我们也相信这项研究将有助于 了解哪些因素可能作为早期放电的促进因素和障碍。

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.