工作量减少对住院医师出院小结质量的影响。
The effect of workload reduction on the quality of residents' discharge summaries.
机构信息
Department of Medicine, Brigham and Women's Hospital, 221 Longwood Ave., RF-291, Boston, MA 02115, USA.
出版信息
J Gen Intern Med. 2011 Jan;26(1):28-32. doi: 10.1007/s11606-010-1465-z. Epub 2010 Aug 10.
BACKGROUND
The completeness of hospital discharge summaries may reflect the overall quality of inter-professional communications. The effect of reducing resident workload on clinical performance is largely unknown.
OBJECTIVE
We examined the impact of reducing housestaff workload on the quality of discharge summaries, an indicator of clinical performance, as compared to discharge summaries created by trainees on a team with a more typical workload.
DESIGN
Patients admitted to a medicine service at a community teaching hospital affiliated with an academic medical center were alternately allocated between a control and intervention care team of residents. First-year residents on the intervention team carried an average census of 3.5 patients compared with 6.6 patients for peers on the control team. A random selection of 142 discharge summaries from a 3-month period were blindly evaluated using a structured tool based on professional documentation standards.
PARTICIPANTS
61 internal medicine residents.
MAIN RESULTS
Inter-rater reliability of discharge summary quality was 0.9. Discharge summaries produced by residents on the intervention team with a reduced workload had significantly more of the required elements (74 vs 65%, p<0.001). Intervention team summaries were more frequently complete and contained significantly more of the required elements describing the patient history (65.7% vs 36.1%, p=0.0005), the inpatient narrative (47.1% vs 22.2%, p=0.003), discharge planning (20.0% vs 5.5%, p=0.012), and continuity of care (24.3% vs 6.9%, p=0.005). Fewer than a quarter of the summaries reviewed included discharge instructions, information on follow-up care, or a discharge medication list.
CONCLUSIONS
Reducing resident workload can significantly improve discharge summary quality, a measure of resident performance.
背景
医院出院小结的完整性可以反映出跨专业交流的整体质量。减少住院医师工作量对临床绩效的影响在很大程度上尚未可知。
目的
与在工作量更为典型的团队中工作的住院医师所写的出院小结相比，我们研究了减少住院医师工作量对出院小结质量（临床绩效的一个指标）的影响，出院小结质量作为一种指标，评估了跨专业交流的整体质量。
设计
将在一所学术医疗中心附属社区教学医院内科病房住院的患者，交替分配到一个控制组和干预组的医护团队中。干预组的第一年住院医师平均负责 3.5 名患者，而对照组的同职级住院医师平均负责 6.6 名患者。在 3 个月期间，从随机选择的 142 份出院小结中，使用基于专业文件标准的结构化工具对其进行了盲法评估。
参与者
61 名内科住院医师。
主要结果
出院小结质量的评分者间可靠性为 0.9。与工作量更大的对照组相比，工作量减少的干预组住院医师所写的出院小结有显著更多的必需元素（74% vs 65%，p<0.001）。干预组的出院小结更完整，且包含了更多必需的患者病史描述（65.7% vs 36.1%，p=0.0005）、住院叙事（47.1% vs 22.2%，p=0.003）、出院计划（20.0% vs 5.5%，p=0.012）和连续性护理（24.3% vs 6.9%，p=0.005）。不到四分之一的审查出院小结包含出院医嘱、随访护理信息或出院药物清单。
结论
减少住院医师工作量可显著提高出院小结质量，这也是住院医师绩效的一项指标。
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