Knickman J R, Lipkin M, Finkler S A, Thompson W G, Kiel J
Robert F. Wagner Graduate School of Public Service (WSPS), New York University (NYU), N.Y. 10003.
Acad Med. 1992 Jul;67(7):429-38. doi: 10.1097/00001888-199207000-00003.
Both the number of residents and the amount of time existing residents have in which to carry out their activities may soon be decreasing. To consider the potential for alternative ways of staffing teaching hospitals, it is necessary to know how residents spend their time. The authors sought to learn this by conducting a time-motion study of eight internal medicine residents at two urban hospitals in New York City in 1988. The residents' activities were observed and coded by premedical students, and the authors independently classified the possible activities into (1) those that had to be done by a physician, (2) those that were educational only, and (3) those that could be done by a non-physician. A total of 1,726 activities of 67 kinds were coded, averaging 7.75 minutes each. The authors analyze and project their data using two models--the traditional model of care in which the physician is the primary medical manager of the patient, and an alternative model in which a midlevel practitioner, such as a nurse practitioner, would perform the day-to-day monitoring of patients. For example, the data indicate that in the traditional model, almost half of a resident's time is spent in activities that must be done by a physician, meaning that another kind of physician would be needed to do those activities if the resident were unavailable; but in the midlevel practitioner model, only around 20% of the activities would require a physician. The authors give detailed breakdowns of their data, estimate the kinds and numbers of non-physician health care professionals necessary to substitute for residents in appropriate activities, and review possible difficulties in implementing such substitutions.
住院医师的数量以及现有住院医师开展活动的时间可能很快都会减少。为了考虑教学医院人员配置的替代方式的可能性，有必要了解住院医师是如何利用他们的时间的。作者们试图通过在1988年对纽约市两家城市医院的8名内科住院医师进行时间动作研究来了解这一点。住院医师的活动由医学预科学生进行观察和编码，作者们独立地将可能的活动分为：(1) 那些必须由医生完成的活动；(2) 那些仅具有教育性质的活动；(3) 那些可以由非医生完成的活动。总共对67种1726项活动进行了编码，每项活动平均用时7.75分钟。作者们使用两种模型对他们的数据进行分析和预测——一种是传统的医疗护理模式，即医生是患者的主要医疗管理者；另一种是替代模式，即由中级从业者（如执业护士）对患者进行日常监测。例如，数据表明，在传统模式下，住院医师几乎一半的时间都花在了必须由医生完成的活动上，这意味着如果住院医师无法完成这些活动，就需要另一种医生来做；但在中级从业者模式下，只有大约20%的活动需要医生。作者们详细列出了他们的数据，估计了在适当活动中替代住院医师所需的非医生医疗保健专业人员的种类和数量，并审视了实施这种替代可能遇到的困难。
