POST-CALL TRANSFER OF RESIDENT RESPONSIBILITY - ITS EFFECT ON PATIENT-CARE

被引：101

作者：

LOFGREN, RP

GOTTLIEB, D

WILLIAMS, RA

RICH, EC

机构：

[1] the Department of Internal Medicine, Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota

[2] the Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

[3] the Department of Internal Medicine, St. Paul Ramsey Medical Center, University of Minnesota, St. Paul, Minnesota

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

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 1990年 / 5卷 / 06期

关键词：

continuity of care; cost of care; laboratory testing; resident education; transfer of care; use of bospital resources;

D O I：

10.1007/BF02600880

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 whether transferring the care of patients to another senior resident the day after admission to the bospital adversely affects the efficiency and quality of care. Design:Retrospective analysis of a natural experiment. Setting:The general medical service of the Minneapolis Veterans Affairs Medical Center, a major tertiary teaching hospital of the University of Minnesota internal medicine residency program. Patients/participants:Subjects were all the patients admitted to the medicine service from 5:00 PM to 6:00 AM over an eight-month period. Intervention:After 5:00 PM, half of the patients were admitted to the hospital by a cross-covering senior resident (CC group of patients), and their care was transferred to a different senior resident the following day. The other patients were initially evaluated by the primary senior resident (PE group of patients). Assignment to the different services was a random, sequential process. Measurements and main results:The CC group had significantly more laboratory tests performed during their hospital stay than did the PE group of patients (44 vs. 32, p=0.01), even when adjusted for length of stay. Using multiple linear regression to adjust for other clinical parameters including length of stay, DRG weight, and number of consults, the authors found that being a CC subject was a significant predictor of the number of laboratory tests obtained (p=0.01). Furthermore, the median length of stay in the CC group (n=74) was longer than that in the PE group (n=72) (eight days vs. six days); this was of borderline statistical significance, using a two-sample median test (p=0.06). Conclusion:Patients transferred to a different resident the day after admission had more laboratory tests performed and longer inpatient stays. © 1987 Society of General Internal Medicine.

引用

页码：501 / 505

页数：5

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