评估外科住院医师对医院质量和运营指标的影响。

IF 2.6 3区医学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES

Journal of Surgical Education Pub Date : 2025-02-01 DOI:10.1016/j.jsurg.2024.103374

Samantha Scarola DO, Linda Morrison, Alex Gandsas MD, MBA, Mitchell Cahan MD, MBA, Justin Turcotte PhD, Adam Weltz MD

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引用次数: 0

摘要

目的：本研究的目的是进行一项跟踪分析，比较住院前阶段的操作和质量指标与一个由15名住院医生组成的成熟项目的操作和质量指标，每个研究生年（PGY） 1-5有3名住院医生。设计：回顾性分析在单一地区医疗中心进行的25,900例手术，包括普通外科、乳房外科、整形外科、胸外科和血管外科，并将手术分为住院医师前期和住院医师期。独立变量包括患者人口统计、合并症负担、急诊科就诊人数，感兴趣的结果包括每日可选病例量、非工作时间（定义为7p-7a）的病例百分比、手术室（OR）和手术时间、平均住院时间（LOS）、平均总住院费用、30天重返手术室（ROR）的比率、急诊科就诊次数、再入院率和患者满意度。单因素和多因素分析比较住院期前和住院期的结果。环境：卢米尼斯健康安妮阿伦德尔医疗中心，马里兰州安纳波利斯，一个社区医院和三级护理中心，拥有3个研究生医学教育项目。参与者：25,900例由普通、乳房、整形、胸部和血管服务部门执行的手术病例。结果：回顾了25,900例手术，在住院医师人数充足的情况下，非工作时间手术的几率增加了14.5%，30天内返回手术室的几率降低了23.9%，30天内再入院的几率降低了17.1%。此外，住院时间减少了半天。手术时间和手术时间均增加后，增加了一个完整的住院补充。以上结果均有统计学意义。结论：外科住院医师似乎通过在不增加费用的情况下改善预后，以及提高急诊手术护理的可获得性，提高了向患者提供手术护理的价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Evaluating the Impact of Surgical Residents on Hospital Quality and Operational Metrics

OBJECTIVE

The purpose of this study is to conduct a follow up analysis comparing operational and quality measures of the pre-residency period with those of a mature program comprised of a full cohort of 15 residents, with 3 residents in each post graduate year (PGY) 1-5.

DESIGN

A retrospective review of 25,900 surgeries performed by the general, breast, plastics, thoracic, and vascular services at a single regional medical center was performed and surgeries were classified as pre-residency period and residency period. Independent variables included patient demographics, comorbidity burden, emergency department arrivals, and outcomes of interest included daily elective case volume, the percent of cases performed during ‘off-hours’ (defined as 7p-7a), operating room (OR) and procedure minutes, average length of stay (LOS), average total hospital charges, rates of 30-day return to OR (ROR), ED visits, and readmissions, and patient satisfaction. Univariate and multivariate analysis performed to compare pre-residency period outcomes with residency period outcomes.

SETTING

Luminis Health Anne Arundel Medical Center, Annapolis, Maryland, a community hospital and tertiary care center, home to 3 graduate medical education programs.

PARTICIPANTS

25,900 surgical cases performed by the general, breast, plastics, thoracic, and vascular services.

RESULTS

25,900 surgeries reviewed and with a full complement of residents the odds of cases being performed off hours increased by 14.5%, odds of 30-day return to the OR decreased by 23.9%, and odds of 30-day readmission decreased by 17.1%. Additionally, length of stay was decreased by ½ day. OR time and procedure time both increased after the addition of a full resident complement. All of these findings were of statistical significance.

CONCLUSIONS

Surgical residents appear to enhance the value of surgical care delivered to patients by improving outcomes without increasing costs, as well as improving the availability of emergency surgical care.

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来源期刊

Journal of Surgical Education EDUCATION, SCIENTIFIC DISCIPLINES-SURGERY

CiteScore

5.60

自引率

10.30%

发文量

261

审稿时长

48 days

期刊介绍： The Journal of Surgical Education (JSE) is dedicated to advancing the field of surgical education through original research. The journal publishes research articles in all surgical disciplines on topics relative to the education of surgical students, residents, and fellows, as well as practicing surgeons. Our readers look to JSE for timely, innovative research findings from the international surgical education community. As the official journal of the Association of Program Directors in Surgery (APDS), JSE publishes the proceedings of the annual APDS meeting held during Surgery Education Week.