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Abstrakt

Hospitalists at Emergency Department Can Improve the Effectiveness of Pre-hospitalized Patients Care

Chun-Minn Yang, Tzu-Chieh Weng, Hui-Juan Lin, Chien-Chin Hsu and Kao-Chang Lin

Introduction: The hospitalists care model (HOS) was performed in the United States (US) since 1996, with good evidence in patients care, saved medical expenses, and improved patient satisfaction. It was applied to Taiwan since 2009 setting at wards with similar efficacy in care quality. The first implementation at emergency department (ED) in a medical center in southern Taiwan was undertaken since 2012 to care all the pre-hospitalized patients at ED.
Purpose: To observe weather this pivotal HOS model at ED worked functioning with good outcomes for patients care, shortened waiting time for hospitalization, reduced mortality, and increased patient satisfaction compared to previously.
Methods: A pilot approach with eight internal attending physicians as a team (Holistic Care Unit-HCU) at observation room nearby ED to care all patients for hospitalization referred by emergency physicians. Parameters were estimated including waiting time, mortality rate, and patient satisfaction, etc., with a proper statistical analysis used for significance.
Results: The waiting time for admission declined 17.3% (p=0.017), overstayed (> 48 hours at ED) declined from 7.83% to 4.91% (p=0.087) before and after HOS setting. The mortality rate decreased 50% with statistically significant (p=0.008) by 24-hour HCU care during pre-hospitalized period. The satisfaction (very satisfied, satisfied) to physician attitude, disease explanation, symptom relief and overall care quality using 5-point Likert scale was 99.1%, 92.8%, 92.0% and 95.3% respectively in total 427 subjects.
Conclusion: Our first-shot HOS model at ED improved patients care quality, lessened waiting time and mortality, and increased satisfaction. It is the creative experience at ED as similar outcome in care quality as at wards. Although it was the only one medical center database, it deserved further research to realize the evidence of improvement.