RESUMO
Emma Dermody leads a hospital-based specialist nursing team working with patients who have alcohol-related problems. They aim to reduce admissions by early intervention.
Assuntos
Consumo de Bebidas Alcoólicas , Alcoolismo/enfermagem , Alcoolismo/prevenção & controle , Promoção da Saúde/métodos , Educação de Pacientes como Assunto , Alcoolismo/epidemiologia , Humanos , Reino Unido/epidemiologiaRESUMO
BACKGROUND: For gastroenterology, The Royal College of Physicians reiterates the common practice of two to three consultant ward rounds per week. The Royal Bolton Hospital NHS Foundation Trust operated a 26-bed gastroenterology ward, covered by two consultants at any one time. A traditional system of two ward rounds per consultant per week operated, but as is commonplace, discharges peaked on ward round days. OBJECTIVE: To determine whether daily consultant ward rounds would improve patient care, shorten length of stay and reduce inpatient mortality. METHODS: A new way of working was implemented in December 2009 with a single consultant taking responsibility for all ward inpatients. Freed from all other direct clinical care commitments for their 2 weeks of ward cover, they conducted ward rounds each morning. A multidisciplinary team (MDT) meeting followed immediately. The afternoon was allocated to gastroenterology referrals and reviewing patients on the medical admissions unit. RESULTS: The changes had an immediate and dramatic effect on average length of stay, which was reduced from 11.5 to 8.9 days. The number of patients treated over 12 months increased by 37% from 739 to 1010. Moreover, the number of deaths decreased from 88 to 62, a reduction in percentage mortality from 11.2% to 6%. However, these major quality outcomes involved a reduction in consultant-delivered outpatient and endoscopy activity. CONCLUSION: This new method of working has both advantages and disadvantages. However, it has had a major impact on inpatient care and provides a compelling case for consultant gastroenterology expansion in the UK.
Assuntos
Consultores , Gastroenterologia/organização & administração , Gastroenteropatias/terapia , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Admissão e Escalonamento de Pessoal , Visitas de Preceptoria , Análise Custo-Benefício , Feminino , Gastroenterologia/normas , Gastroenteropatias/economia , Gastroenteropatias/mortalidade , Departamentos Hospitalares/organização & administração , Mortalidade Hospitalar/tendências , Humanos , Tempo de Internação/economia , Masculino , Programas Nacionais de Saúde/economia , Equipe de Assistência ao Paciente , Alta do Paciente/estatística & dados numéricos , Encaminhamento e Consulta , Visitas de Preceptoria/economia , Reino Unido/epidemiologiaRESUMO
BACKGROUND: For gastroenterology, The Royal College of Physicians reiterates the common practice of two to three consultant ward rounds per week. The Royal Bolton Hospital NHS Foundation Trust operated a 26-bed gastroenterology ward, covered by two consultants at any one time. A traditional system of two ward rounds per consultant per week operated, but as is commonplace, discharges peaked on ward round days. OBJECTIVE: To determine whether daily consultant ward rounds would improve patient care, shorten length of stay and reduce inpatient mortality. METHODS: A new way of working was implemented in December 2009 with a single consultant taking responsibility for all ward inpatients. Freed from all other direct clinical care commitments for their 2 weeks of ward cover, they conducted ward rounds each morning. A multidisciplinary team (MDT) meeting followed immediately. The afternoon was allocated to gastroenterology referrals and reviewing patients on the medical admissions unit. RESULTS: The changes had an immediate and dramatic effect on average length of stay, which was reduced from 11.5 to 8.9 days. The number of patients treated over 12 months increased by 37% from 739 to 1010. Moreover, the number of deaths decreased from 88 to 62, a reduction in percentage mortality from 11.2% to 6%. However, these major quality outcomes involved a reduction in consultant-delivered outpatient and endoscopy activity. CONCLUSION: This new method of working has both advantages and disadvantages. However, it has had a major impact on inpatient care and provides a compelling case for consultant gastroenterology expansion in the UK.
