Oswanski Michael F, Sharma Om P, Raj Shekhar S
Trauma Services Department, The Toledo Hospital/The Toledo Children's Hospital, Ohio, USA.
Am Surg. 2004 Mar;70(3):272-9.
In view of the new residency guidelines, which restrict resident work hours, the use of physician assistants (PAs) for patient care continuity during off-hours of residents may become a common practice. The purpose of this study was to assess the quality of patient care during transition from resident- to PA-assisted trauma program (without residents) and comparative simultaneous support. A retrospective analysis of patient care during two 6-month segments was carried out: during resident-assisted program at a level II trauma center in 1998 and a PA-dedicated trauma program in 1999. With reinvolvement of senior surgical residents, a focused analysis for the last quarter of 2002 was done. Regression analysis indicated the only statistically significant outcome was decreased length of stay (LOS) when patients were transferred directly from emergency center (EC) to floor in 1999. The mean LOS was 2.54 +/- 4.65 compared to 3.4 +/- 5.81, and no statistical difference in other assessments was noted. Focused analysis in 2002 showed 100 per cent participation of PAs during the trauma alert compared to 51 per cent by residents. Substitution of residents with PAs had no impact on patient mortality; however, LOS (from EC to floor), was statistically reduced by 1 day. Trauma programs can benefit with collaboration of residents and PAs in patient care.
鉴于新的住院医师培训指南限制了住院医师的工作时间，在住院医师非工作时间使用医师助理（PA）来维持患者护理的连续性可能会成为一种常见做法。本研究的目的是评估从住院医师辅助创伤项目（无住院医师）过渡到医师助理辅助创伤项目以及对比同时提供支持期间的患者护理质量。对两个6个月时间段内的患者护理情况进行了回顾性分析：1998年在一家二级创伤中心的住院医师辅助项目期间以及1999年的医师助理专用创伤项目期间。随着高级外科住院医师的再次参与，对2002年最后一个季度进行了重点分析。回归分析表明，唯一具有统计学意义的结果是1999年患者从急诊中心（EC）直接转至病房时住院时间（LOS）缩短。平均住院时间为2.54±4.65天，而之前为3.4±5.81天，其他评估未发现统计学差异。2002年的重点分析显示，在创伤警报期间医师助理的参与率为100%，而住院医师为51%。用医师助理替代住院医师对患者死亡率没有影响；然而，从急诊中心到病房的住院时间在统计学上缩短了1天。创伤项目在住院医师和医师助理合作进行患者护理方面会有所受益。
