1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC. 2Division of Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA.
Pediatr Crit Care Med. 2014 Feb;15(2):97-104. doi: 10.1097/PCC.0000000000000032.
To characterize the current state of 24/7 in-hospital pediatric intensivist coverage in academic PICUs, including perceptions of faculty and trainees regarding the advantages and disadvantages of in-hospital coverage.
Cross-sectional observational study via web-based survey.
PICUs at North American academic institutions.
Pediatric intensivists, pediatric critical care fellows, and pediatric residents.
None.
A total of 1,323 responses were received representing a center response rate of 74% (147 of 200). Ninety percent of respondents stated that in-hospital coverage is good for patient care, and 85% stated that in-hospital coverage provides safer care. Sixty-three percent of intensivists stated that working in in-hospital models limits academic productivity, and 65% stated that in-hospital models interfere with nonclinical responsibilities. When compared with intensivists in home coverage models, intensivists working in in-hospital models generally had more favorable perceptions of the effects of in-hospital on patient care (p < 0.0001) and faculty quality of life. Physician burnout was measured with the abbreviated Maslach Burnout Inventory. Although 57% of intensivists responded that working in in-hospital models increases burnout risk, burnout scores were not different between coverage models. Seventy-nine percent of intensivists currently working at institutions with in-hospital coverage stated that they would prefer to work in an in-hospital coverage model, compared with 31% of those working in a home coverage model (p < 0.0001).
Although concerns exist regarding the effect of 24/7 in-hospital coverage on faculty, the majority of pediatric intensivists and critical care trainees responded that in-hospital coverage by intensivists is good for patient care. The majority of intensivists also state that they would prefer to work at an institution with in-hospital coverage. Further research is needed to objectively delineate the effects of in-hospital coverage on both patients and faculty.
描述学术型儿科重症监护病房（PICU）24/7 院内儿科 intensivist 覆盖的现状，包括教职员工和学员对院内覆盖的优缺点的看法。
通过网络调查进行横断面观察性研究。
北美学术机构的 PICU。
儿科 intensivist、儿科重症监护研究员和儿科住院医师。
无。
共收到 1323 份回复，代表中心回复率为 74%（200 个中心中的 147 个）。90%的受访者表示，院内覆盖有利于患者护理，85%的受访者表示，院内覆盖提供更安全的护理。63%的 intensivist 表示，在院内模式下工作限制了学术生产力，65%的 intensivist 表示，院内模式干扰了非临床职责。与在家中覆盖模式下工作的 intensivist 相比，在院内模式下工作的 intensivist 普遍对院内对患者护理（p < 0.0001）和教职员工生活质量的影响有更有利的看法。医师倦怠用简短的 Maslach 倦怠量表进行衡量。尽管 57%的 intensivist 表示，在院内模式下工作会增加倦怠风险，但覆盖模式之间的倦怠评分并无差异。目前在设有院内覆盖的机构工作的 79%的 intensivist 表示，他们更愿意在院内覆盖模式下工作，而在家中覆盖模式下工作的 intensivist 中，这一比例为 31%（p < 0.0001）。
尽管人们对 24/7 院内覆盖对教职员工的影响存在担忧，但大多数儿科 intensivist 和重症监护研究员表示， intensivist 的 24/7 院内覆盖对患者护理有益。大多数 intensivist 还表示，他们更愿意在设有院内覆盖的机构工作。需要进一步的研究来客观地描述院内覆盖对患者和教职员工的影响。
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