Bekmezian Arpi, Chung Paul J, Yazdani Shahram
Division of General Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California 94143-0110, USA.
J Hosp Med. 2009 Feb;4(2):90-6. doi: 10.1002/jhm.403.
Few studies exist on the ability of standardized preprinted order forms to improve patient care.
To examine resident-perceived effects of introducing a pediatric admission order set (PAOS) on the quality of inpatient care.
Cross-sectional study.
University of California, Los Angeles (UCLA) Children's Hospital, a nonprofit, tertiary-care teaching hospital and major referral center with approximately 3,000 admissions per year.
A total of 97 pediatric residents (PL-1, n=34; PL-2, n=33; and PL-3, n=30) who did the vast majority of the inpatient admissions.
Residents were asked to rate the PAOS overall and with respect to 9 specific dimensions using a 5-point Likert scale.
Overall, 89% of respondents approved of the PAOS, 58% reported using it >or= 90% of the time, and all said that they would recommend it to their colleagues. Eighty-four percent thought that it improved inpatient care, and 75% thought that medical errors were reduced. Eighty-eight percent reported that the PAOS saved time; 93% said it was convenient; and most reported less need for clarification with secretaries (81%) and nurses (82%). In multivariate regression analyses, the only predictor of overall rating was whether the PAOS improved inpatient care (P=0.04). Improved patient care, meanwhile, was predicted by whether the PAOS was comprehensive (P=0.01), reduced medical errors (P=0.01), and required less clarification with nurses (P=0.01).
A standardized admission order set is a simple, low-cost intervention that residents believe may benefit patients by reducing medical errors and expediting high-quality care.
关于标准化预印医嘱单改善患者护理能力的研究较少。
探讨引入儿科入院医嘱集（PAOS）对住院护理质量的住院医师认知效果。
横断面研究。
加利福尼亚大学洛杉矶分校（UCLA）儿童医院，一家非营利性三级护理教学医院及主要转诊中心，每年约有3000例入院病例。
总共97名儿科住院医师（PL - 1，n = 34；PL - 2，n = 33；PL - 3，n = 30），他们负责绝大多数的住院患者收治工作。
要求住院医师使用5点李克特量表对PAOS整体以及9个具体维度进行评分。
总体而言，89%的受访者认可PAOS，58%的人报告使用频率≥90%，所有人都表示会向同事推荐。84%的人认为它改善了住院护理，75%的人认为减少了医疗差错。88%的人报告PAOS节省了时间；93%的人表示它很方便；大多数人报告与秘书（81%）和护士（82%）沟通时需要澄清的情况减少。在多变量回归分析中，总体评分的唯一预测因素是PAOS是否改善了住院护理（P = 0.04）。与此同时，PAOS是否全面（P = 0.01）、减少医疗差错（P = 0.01）以及与护士沟通时需要澄清的情况较少（P = 0.01）可预测患者护理的改善。
标准化入院医嘱集是一种简单、低成本的干预措施，住院医师认为它可能通过减少医疗差错和加快高质量护理而使患者受益。
