RESUMO
PURPOSE: To evaluate the impact of implementing a hospitalist service with a nurse discharge planner in an academic teaching hospital. SUBJECTS AND METHODS: Inpatient medicine service was provided by hospitalists, general internists, and specialists. Service personnel were identical except that the hospitalist service also had a nurse discharge planner. Hospitalists attended 4 months per year (compared with the 1 month by most other attending physicians) and had no outpatient responsibilities during the ward months. Patients were admitted alternately based on resident call schedule. Major outcomes included average costs of hospitalization, length of stay, and resource utilization. Quality measures included inpatient mortality, 30-day readmission rates, and satisfaction of patients, residents and students. RESULTS: Hospitalist-attended services had lower mean (+/- SD) inpatient costs per patient ($4289 +/- $6512) compared with specialist-staffed services ($6066 +/- $7550, P < 0.0001), with a trend toward lower costs when compared with generalist-attended services ($4850 +/- $7027, P = 0.11). Hospitalist services had shorter mean lengths of stay (4.4 +/- 4.0 days), compared with generalists (5.2 +/- 5.2 days) and specialists (6.0 +/- 5.5 days, P < 0.0001 for hospitalists vs. both groups). Readmission rates were similar in all groups. Mortality rates were higher in the specialist group [5.0% (44 of 874)] compared with hospitalists [2.2% (18 of 829)] and generalists [2.6% (20 of 761), P = 0.002 for specialists vs. both groups, P = 0.09 for generalists vs hospitalists]. Satisfaction results were uniformly high in all groups, with no significant differences. CONCLUSION: Hospitalist services with a nurse discharge planner were associated with lower average cost and shorter average length of hospital stay, without any apparent compromise in clinical outcomes or patient satisfaction.
Assuntos
Médicos Hospitalares/economia , Hospitais de Ensino/economia , Enfermeiras e Enfermeiros , Assistência ao Paciente/economia , Alta do Paciente/economia , Qualidade da Assistência à Saúde/economia , Adulto , Idoso , Atitude do Pessoal de Saúde , Feminino , Alocação de Recursos para a Atenção à Saúde/economia , Mortalidade Hospitalar , Hospitalização/economia , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Admissão do Paciente/economia , Satisfação do Paciente/economiaAssuntos
Síndrome da Criança Espancada/complicações , Síndrome da Criança Espancada/diagnóstico , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Papiledema/diagnóstico , Papiledema/etiologia , Feminino , Hematoma Subdural/diagnóstico , Hematoma Subdural/etiologia , Humanos , Lactente , Imageamento por Ressonância Magnética , Hemorragia Subaracnoídea Traumática/diagnóstico , Hemorragia Subaracnoídea Traumática/etiologia , Tomografia Computadorizada por Raios XRESUMO
In an effort to increase continuity of inpatient care by attending physicians, decrease use of hospital resources, and improve medical education without compromising quality of care, an inpatient pediatric ward service was restructured by using concepts developed by hospitalists. This reorganization reduced the number of yearly inpatient attendings, added a consistent 14-day call schedule, and eliminated attending outpatient responsibilities during their ward service. The restructured ward service attending acted as the attending of record for all general and specialty patients, excluding hematology/oncology, with the subspecialists fulfilling a consultant role. To evaluate the impact of this restructuring, a baseline year of the traditional ward service (TWS) was compared with a subsequent year of the restructured ward service (RWS). Our goal was to evaluate the impact of this new system on average costs of hospitalization, length of stay, resource utilization, inpatient mortality, and 7- and 31-day readmission rates. Hospital costs per patient were lower by 13% (p=0.018) in the restructured system. Average lengths of stay in an observation bed were significantly lower on the RWS (p=0.007), but there was no significant difference in admission length of stay. There was decreased resource utilization for laboratory and radiology tests (p<0.01) on the restructured service. Readmission rates were not significantly changed, and satisfaction among attendings, housestaff, students, and patients was uniformly high in both groups. A reorganized academic pediatric medical service, which allows specific attendings to focus on inpatient care and teaching, can decrease hospital resource utilization without compromising the quality of patient care or medical education.
Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Reestruturação Hospitalar , Unidades Hospitalares/organização & administração , Pediatria/organização & administração , Criança , Pré-Escolar , Feminino , Custos Hospitalares , Mortalidade Hospitalar , Unidades Hospitalares/estatística & dados numéricos , Médicos Hospitalares , Humanos , Lactente , Recém-Nascido , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Revisão da Utilização de Recursos de Saúde , West Virginia/epidemiologiaRESUMO
PURPOSE: To describe the clinical and pathologic presentation and course of a 7-week-old girl with anemia, thrombocytopenia, and organomegaly who was found to have a histiocytic disorder distinct from previously reported cases. METHODS: Bone marrow specimens were studied with conventional methods. A liver biopsy specimen was evaluated by routine and immunohistochemical methods and electron microscopy. RESULTS: The patient was found to have a unique histiocytic disorder in which lesional cells displayed an atypical phenotype. Cyclosporine therapy was associated with a prompt, complete, and apparently permanent resolution of disease. CONCLUSION: This case appears to represent an atypical histiocytic disorder with unique clinical and pathologic features. The disorder resolved after the initiation of cyclosporine therapy.