在中午之前增加和维持排放 - - 一个多年的流程改进项目
Ryan Bailey1, Ankur Segon2, Sean Garcia2
1The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA. baileyr1@livemail.uthscsa.edu.
BMC health services research
|April 17, 2024
概括
在中午之前提前出院的增加提高了急诊室 (ED) 的表现和患者的结果. 这个过程改进项目成功地提高了早期出院率,而不会对关键的患者安全指标产生负面影响.
科学领域:
- 医疗保健管理的管理
- 过程改进 过程改进
- 医院运营 医院运营
背景情况:
- 高医院占用率对急诊室 (ED) 的表现产生负面影响,导致等待时间增加和患者的不良结果.
- 迟到的患者出院是导致长时间住院和ED过度拥挤的重要因素.
- 优化出院时间对于提高医院效率和患者护理至关重要.
研究的目的:
- 描述一项旨在增加和维持大型学术医疗中心早期出院的流程改进计划.
- 评估干预措施对早出院比例和医院关键绩效指标的影响.
- 为其他学术设施提供可扩展的路线图,旨在改善准时释放.
主要方法:
- 实施41个月的代计划-做-研究-行动 (PDSA) 周期,遵循医学研究所改善模式.
- 引入多种,不断发展的干预措施,旨在促进患者更早出院.
- 持续监测绩效指标,包括出院时间,风险调整停留时间 (RA-LOS),死亡率和再接收.
主要成果:
- 早上10点前下放命令的比例显著增加,从8.7%增加到22.2% (p < 0.001).
- 中午排放的比例 (DBN) 从9.5%大幅上升至26.8% (p < 0.001).
- 关键平衡指标显示没有负面影响;RA-LOS下降 (1.16至1.09,p=0.01),RA-再接收下降 (0.92至0.74,p<0.001).
结论:
- 在大型学术医疗中心,通过系统的流程改进,可以实现早期出院的持续增加.
- 实施的战略提高了医院的效率,而不会影响患者的安全或增加再入院.
- 多学科参与,适应能力和机构支持对于成功实施和可持续性至关重要.
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