Department of Medicine, University of Colorado Denver School of Medicine, Denver, CO 80220, USA.
JAMA Intern Med. 2013 Jun 24;173(12):1084-9. doi: 10.1001/jamainternmed.2013.6041.
General medicine rounds by attending physicians provide the foundation for patient care and education in teaching hospitals. However, the detailed activities of these rounds in the current era are not well characterized.
To describe the characteristics of attending rounds for internal medicine inpatients in a large teaching hospital system.
A cross-sectional observational study of attending rounds in internal medicine. Rounds were observed directly by research assistants.
Four teaching hospitals associated with a large public medical school.
Fifty-six attending physicians and 279 trainees treating 807 general medicine inpatients.
Duration and location of rounds, composition of teams, and frequency of 19 potential activities during rounds.
We observed 90 days of rounds. A typical rounding day consisted of 1 attending with 3 trainees visiting a median of 9 (range, 2-18 [SD, 2.9]) patients for a median of 2.0 hours (range, 25-241 [SD, 2.7] minutes). On rounds, teams most frequently discussed the patient care plan (96.7% of patients), reviewed diagnostic studies (90.7%), communicated with patients (73.4%), and discussed the medication list (68.8%). Teams infrequently discussed invasive lines or tubes (9.3%) or nursing notes (6.2%) and rarely communicated with nurses (12.0%) or taught physical examination skills (14.6%), evidence-based medicine topics (7.2%), or learner-identified topics (3.2%). Many commonly performed activities occurred infrequently at the bedside.
Most activities on attending rounds do not take place at the bedside. The teams discuss patient care plans and test results most of the time but fail to include many items that may be of significant value, including specific aspects of patient care, interprofessional communication, and learner-centered education. Future studies are needed to further assess the implications of these observations.
主治医生的普通医学查房为教学医院的患者护理和教育提供了基础。然而，当前时代这些查房的详细活动并未得到很好的描述。
描述大型教学医院系统中内科住院患者主治医生查房的特点。
对内科查房进行的一项横断面观察性研究。研究助理直接观察查房。
与大型公立医学院相关的 4 所教学医院。
56 名主治医生和 279 名治疗 807 名普通内科住院患者的实习生。
查房的持续时间和地点、团队组成以及查房期间 19 项潜在活动的频率。
我们观察了 90 天的查房。典型的查房日由 1 名主治医生和 3 名实习生组成，平均访问 9（范围，2-18 [SD，2.9]）名患者，平均查房时间为 2.0 小时（范围，25-241 [SD，2.7]分钟）。在查房期间，团队最常讨论患者护理计划（96.7%的患者）、审查诊断研究（90.7%）、与患者沟通（73.4%）和讨论药物清单（68.8%）。团队很少讨论侵入性线路或导管（9.3%）或护理记录（6.2%），很少与护士沟通（12.0%）或教授体格检查技能（14.6%）、循证医学主题（7.2%）或学习者确定的主题（3.2%）。许多常见的活动很少在床边进行。
大多数主治医生查房活动不在床边进行。团队大部分时间讨论患者护理计划和测试结果，但未能包括许多可能具有重要价值的项目，包括患者护理的具体方面、跨专业沟通和以学习者为中心的教育。需要进一步研究来评估这些观察结果的意义。
