O'Toole Jennifer K, Solan Lauren G, Yau Connie, Weiser Jason, Sucharew Heidi, Simmons Jeffrey M
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Hosp Pediatr. 2013 Apr;3(2):162-6. doi: 10.1542/hpeds.2012-0100.
The goal of this study was to measure the impact of the new 2011 Accreditation Council for Graduate Medical Education duty hour standards (DHS) on education, patient care, and overall satisfaction as perceived by pediatric hospitalist faculty.
We undertook a nonrandomized but controlled study of 23 pediatric hospitalist faculty members during a trial of the new DHS in 2011. During the intervention (January), residents piloted schedules that complied with the new DHS, and in the control period (February), resident schedules complied with previous DHS. Daily surveys solicited faculty perceptions of the amount and quality of teaching provided, time with patients, quality of patient care, and overall faculty satisfaction. Faculty were also surveyed on their years of experience as a hospitalist and clinical teaching activity. Multiple logistic regression analysis with generalized estimating equations was used to examine outcome associations after adjusting for census and accounting for multiple attending reports.
Census volumes were higher in the control group. During the intervention, faculty were less likely to rate their quality of teaching (odds ratio [OR]: 0.40 [95% confidence interval (CI): 0.18-0.88]) and overall satisfaction with the shift (OR: 0.23 [95% CI: 0.08-0.66]) as good/excellent compared with controls. During the intervention, more years of experience as a hospitalist were associated with rating quality of patient care provided as good/excellent (OR: 1.77 [95% CI: 1.23-2.54]).
Faculty were less likely to rate their quality of teaching and overall satisfaction as good/excellent during a trial of the 2011 DHS. In addition, more experienced faculty were more likely to rate the quality of care highly.
本研究旨在衡量2011年研究生医学教育认证委员会（ACGME）新的工作时间标准（DHS）对儿科住院医师培训教员所感知的教育、患者护理及总体满意度的影响。
2011年在新DHS试行期间，我们对23名儿科住院医师培训教员进行了一项非随机但有对照的研究。在干预期（1月），住院医师试用符合新DHS的排班表，在对照期（2月），住院医师排班表符合之前的DHS。每日调查收集教员对教学量和质量、与患者相处时间、患者护理质量及教员总体满意度的看法。还就教员作为住院医师的工作年限和临床教学活动对其进行了调查。采用广义估计方程的多重逻辑回归分析来检验在调整普查情况并考虑多位主治医生报告后结果的相关性。
对照组的普查量更高。在干预期，与对照组相比，教员将教学质量评为良好/优秀（优势比[OR]：0.40[95%置信区间（CI）：0.18 - 0.88]）以及对班次总体满意度评为良好/优秀（OR：0.23[95%CI：0.08 - 0.66]）的可能性更低。在干预期，作为住院医师的工作年限越长，将所提供的患者护理质量评为良好/优秀的可能性越大（OR：1.77[95%CI：1.23 - 2.54]）。
在2011年DHS试行期间，教员将教学质量和总体满意度评为良好/优秀的可能性更低。此外，经验更丰富的教员更有可能对护理质量给予高度评价。
