Seattle Children's Hospital, Seattle, Washington, USA.
PLoS One. 2010 Jun 21;5(6):e11246. doi: 10.1371/journal.pone.0011246.
Existing observational data describing rounds in teaching hospitals are 15 years old, predate duty-hour regulations, are limited to one institution, and do not include pediatrics. We sought to evaluate the effect of medical specialty, institution, patient-census, and team participants upon time at the bedside and education occurring on rounds.
Between December of 2007 and October of 2008 we performed 51 observations at Lucile Packard Children's Hospital, Seattle Children's Hospital, Stanford University Hospital, and the University of Washington Medical Center of 35 attending physicians. We recorded minutes spent on rounds in three location and seven activity categories, members of the care team, and patient-census.
Results presented are means. Pediatric rounds had more participants (8.2 vs. 4.1 physicians, p<.001; 11.9 vs. 2.4 non-physicians, p<.001) who spent more minutes in hallways (96.9 min vs. 35.2 min, p<.001), fewer minutes at the bedside (14.6 vs. 38.2 min, p = .01) than internal medicine rounds. Multivariate regression modeling revealed that minutes at the bedside per patient was negatively associated with pediatrics (-2.77 adjusted bedside minutes; 95% CI -4.61 to -0.93; p<.001) but positively associated with the number of non-physician participants (0.12 adjusted bedside minutes per non physician participant; 95% CI 0.07 to 0.17; p = <.001). Education minutes on rounds was positively associated with the presence of an attending physician (2.70 adjusted education minutes; 95% CI 1.27 to 4.12; p<.001) and with one institution (1.39 adjusted education minutes; 95% CI 0.26 to 2.53; p = .02).
Pediatricians spent less time at the bedside on rounds than internal medicine physicians due to reasons other than patient-census or the number of participants in rounds. Compared to historical data, internal medicine rounds were spent more at the bedside engaged in patient care and communication, and less upon educational activities.
现有的描述教学医院查房的观察数据已有 15 年的历史，这些数据早于工作时间规定，仅局限于一个机构，并且不包括儿科。我们试图评估医学专业、机构、患者数量和团队参与者对床边时间和查房期间教育的影响。
2007 年 12 月至 2008 年 10 月间，我们在 Lucile Packard 儿童医院、西雅图儿童医院、斯坦福大学医院和华盛顿大学医学中心对 35 名主治医生进行了 51 次观察。我们记录了在三个位置和七个活动类别的查房时间、护理团队成员和患者数量。
呈现的结果是平均值。儿科查房的参与者更多（8.2 名医生对 4.1 名医生，p<.001；11.9 名非医生对 2.4 名非医生，p<.001），在走廊上花费的时间更多（96.9 分钟对 35.2 分钟，p<.001），在床边的时间更少（14.6 分钟对 38.2 分钟，p=0.01）。多变量回归模型显示，每位患者床边的分钟数与儿科呈负相关（-2.77 分钟的调整床边时间；95%置信区间-4.61 至-0.93；p<.001），但与非医生参与者的数量呈正相关（0.12 分钟的调整床边时间每增加一名非医生参与者；95%置信区间 0.07 至 0.17；p<.001）。查房期间的教育时间与主治医生的存在呈正相关（2.70 分钟的调整教育时间；95%置信区间 1.27 至 4.12；p<.001），与一个机构呈正相关（1.39 分钟的调整教育时间；95%置信区间 0.26 至 2.53；p=0.02）。
由于患者数量或查房参与者数量以外的原因，儿科医生在查房时床边的时间少于内科医生。与历史数据相比，内科医生在床边进行患者护理和沟通的时间更多，而进行教育活动的时间更少。
