CALL NIGHTS AND PATIENT-CARE - EFFECTS ON INPATIENTS AT ONE TEACHING HOSPITAL

被引：32

作者：

HILLSON, SD

DOWD, B

RICH, EC

LUXENBERG, MG

机构：

[1] the Department of Medicine, University of Minnesota, St. Paul, Minnesota

[2] the Division of Health Services Research and Policy, School of Public Health, University of Minnesota, St. Paul, Minnesota

[3] the Ramsey Clinic, St. Paul, Minnesota

[4] the Department of Medicine, University of Kentucky, Lexington, Kentucky

[5] Professional Data Analysts, Minneapolis, Minnesota

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 1992年 / 7卷 / 04期

关键词：

WORK SCHEDULE TOLERANCE; INTERNSHIP AND RESIDENCY; TIME FACTORS; FATIGUE; HEALTH PLANNING GUIDELINES; QUALITY OF HEALTH CARE; EDUCATION; NIGHT ADMISSIONS;

D O I：

10.1007/BF02599156

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Objective: To determine whither the timing and number of patients admitted by internal medicine housestaff under a traditional call schedule affect the resource utilization and outcome of cave for those patients. Design: Retrospective cohort study, using existing computerized records. Setting: University-affiliated 340-bed city/county teaching hospital. Patients/participants: 22,112 patients discharged from the internal medicine service who had been admitted by an on-call first-year resident between January 1, 1980, and December 31, 1987. Measurements and main results: Admission after 5:00 PM was associated with decreased hospital length of stay (8.1%, p < 0.001), but increased total charges (3.1% p = 0.007). The relative risk of inpatient mortality for patients admitted at night was 1.21 (p = 0.03). Patients of busier housestaff, as indicated by a larger number of on-call admissions, had lower total charges (1.7% decreased per admission) and no change in risk of inpatient mortality. While no linear relation was found between number of admissions and length of stay, analysis of nonlinear effects revealed that length of stay first rises, then falls as interns receive more on-call admissions. Conclusions: The number and timing of admissions by on-call internal medicine housestaff are significantly related to length of hospital stay, total charges, and likelihood of inpatient mortality at one teaching hospital. These variations should be considered in planning the reform of residency training programs.

引用

页码：405 / 410

页数：6

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