在新时代优化患者进展:一个全面的框架
Laura E Smith1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18, Trancy Escobar1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18, Andrea McCabe1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18
1Laura E. Smith, MD, is Senior Medical Director of Clinical Operations, Department of Care Continuum Management, Office of the Chief Operating Officer, Brigham and Women's Hospital (BWH), Boston, MA.
Professional case management
|February 29, 2024
概括
一个新的患者进展框架通过优化护理过渡来提高了医院的效率和减少住院时间. 该战略提高了急性后资源利用率,并解决了医疗保健机构的能力挑战.
科学领域:
- 医疗保健管理的管理
- 医疗保健服务研究 医疗服务研究
- 医院运营 医院运营
背景情况:
- 随着COVID-19大流行,医院容量危机和人员短缺加剧,增加了对住院服务的需求.
- 延迟的患者吞吐量和长时间的停留时间成为急性和急性后护理环境中的关键问题.
- 新的策略是必不可少的,以便在医疗上准备好时,有效地将患者转移到较低的护理水平.
研究的目的:
- 开发和实施患者进展的战略框架,以提高效率和资源利用.
- 为了捕获患者进展数据,并优化后急性护理资源的使用.
- 在复杂和资源有限的医疗保健环境中应对能力挑战.
主要方法:
- 在战略框架内实施干预措施,以测试患者进展的新护理模式.
- 使用修改后的早期查工具来规划出院计划,以优先考虑病例管理.
- 雇佣了跨学科的护理优化回合和电子健康记录工具,用于沟通和障碍识别.
- 通过专门的复杂护理团队管理高风险患者,并开发了用于运输和住院的专业途径.
- 建立了社区医院遣返和"为什么不回家"运动,用于物理治疗.
主要成果:
- 一个修改后的出院规划工具选了53%的低风险患者,使住院时间减少了0.55天 (p = .083).
- 实施后,文档遵守率超过了98%.
- 一个复杂的护理团队将Case Mix指数调整后的逗留时间减少了2.5%.
- 在10%的病例中,护理货车抵消了传统的运输,在21%的病例中,护理货车能够更早地释放.
- 社区遣返试点为40名患者,在10个月内将退院延迟日减少了1000天.
结论:
- 实施新型患者进展框架提高了运营效率,并对停留时间产生了积极影响.
- 正如布里格姆框架所示,在病例管理中的创新方法可以解决护理过渡挑战.
- 需要进一步的研究,以了解长期的好处,并充分缓解不断变化的能力挑战.
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