将医学复杂的儿童门诊团队与住院医师联系起来，改善了住院护理

据德克萨斯大学健康科学中心的研究人员说，当医疗复杂的儿童住院时，将住院医生与住院咨询服务联系起来的常规门诊服务提供者更有可能改善结果。beplay苹果手机能用吗Uthealth）。

质量改进试验的结果,showed the inpatient consultation service was more likely to reduce total hospital days, hospital admissions and readmissions, days in pediatric intensive care (PICU), and health care system costs, were publishedtoday在贾马儿科。

“We expected to see an improvement in parent satisfaction, but I was surprised to see how significantly an inpatient consultation from the outpatient providers reduced admissions, readmission, and PICU days, as well as total hospital days and health system costs,” said里卡多蚊子，医学博士, first and corresponding author and associate professor of pediatrics at McGovern Medical School at UTHealth. Mosquera is director of the UTHealth High Risk Children’s Program, a collaboration between UTHealth and Children’s Memorial Hermann Hospital.

乔恩·泰森（Jon E. Tyson），医学博士，MPH，儿科系教授兼助理院长是高级作家。

During a one-year period from 2016 to 2017, 167 children were randomized to inpatient consultation service and 175 to usual hospital care for the trial. Results showed that with the inpatient consultation service, the probability of reduced hospital days was 91%; of PICU days was 89%, and of mean total health care system costs was 94%.

总共将住院咨询服务与常规护理进行比较，共有296次与636天的医院天数相比；和24,928美元，每年儿童成本为42,276美元。经济分析是由卫生保健经济学家和第二作者进行的医学博士Elenir Avritscher，博士，麦戈文医学院儿科副教授。

The trial also revealed that parents were more likely to give an overall rating of 9 or 10 (with 10 being the highest) to the providers of inpatient care.

“We knew that families were concerned about not seeing their regular health care provider while their children were in the hospital,” Mosquera said. “It was reassuring for them to see us when necessary for visits in the hospital.”

患有复杂医疗需求的儿童占美国儿童的0.4％，但约有40％的小儿死亡和54％的儿科医院费用。为了帮助这些脆弱的孩子有最好的结果，UT医生高风险儿童诊所由蚊子和一个多学科的卫生保健专家团队建立，从一名患者增长到800。

发表在贾马2014年显示，具有医疗复杂性的高危儿童的门诊综合护理计划降低了急诊就诊，医院和小儿重症监护病房的入院和住宿以及卫生系统费用。2018年，该计划被命名为由美国孕产妇和儿童健康局建立的国家儿童和青少年特殊医疗保健需求。

The UTHealth team recognized a gap because when patients did need to be hospitalized for acute illness, the hospitalists were unfamiliar with the child and their outpatient care, which could provide key insight to their needs while the child was in the hospital.

“为了避免护理，我们认识到我们应该将综合护理扩展到包括住院在内的所有情况，”蚊子说。该诊所还提供远程医疗，并在可能的情况下为患者提供亲自访问。

During the trial, parents of children randomized to the inpatient consultation service were asked to contact the outpatient care team when an emergency department doctor was considering hospitalization for the patient. A study nurse also reviewed the daily log to identify admissions of all study children, including those randomized to usual hospital care.

对于住院咨询服务，门诊诊所提供者在入院，出院后或出院后不久或在住宿期间与更复杂的护理患者（如果需要的话）进行间歇性地与儿童的院内团队进行了交谈。诊所小组还参加了院后计划，在出院后的36小时内将患者称为患者，并安排出院后不超过10天的诊所任命。

蚊子说：“我们的医生与医院主义者或急诊科医师进行了咨询，以确定是否应住院，治疗和护理过程，并解除和过渡到门诊环境。”“但是医院主义团队仍然保留全部责任。我认为，这种模型不仅对儿童很重要，而且无论年龄多大，对任何风险人群都很重要。”

Additional co-authors from the McGovern Medical School Department of Pediatrics and Center for Clinical Research and Evidence Based Medicine includeClaudia Pedroza, PhD;辛西娅·贝尔（Cynthia S. Bell）；Cheryl L. Samuels，RN，PNP；Tomika S. Harris，DNP；朱莉·C·伊普（Julie C. Eapen），医学博士;医学博士Aravind Yadav;米歇尔·坡（Michelle Poe），RN；和Raymond L. Parlar-Chun，医学博士。

The study was supported in part from grant 5KL2TR000370 from the Center for Clinical and Translational Sciences, grant 5 UL1TR00371 from the National Center for Advancing Translational Sciences, and support from the Network Access Improvement Program.

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