将运动原则应用于医疗查房，以提高教学和患者护理水平。

Applying athletic principles to medical rounds to improve teaching and patient care.

机构信息

Dr. Southwick is professor of medicine, Division of Infectious Diseases, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida. Ms. Lewis is case manager, UF Health Shands Hospital, Gainesville, Florida. Dr. Treloar is associate professor of nursing, College of Medicine, University of Florida, Gainesville, Florida. Dr. Cherabuddi is assistant professor of medicine, Division of Infectious Diseases, College of Medicine, University of Florida, Gainesville, Florida. Dr. Radhakrinshan is assistant professor of medicine, Division of Hospitalist Medicine, College of Medicine, University of Florida, Gainesville, Florida. Dr. Leverence is vice chairman of medicine for clinical affairs, professor of medicine, and chief, Division of Hospital Medicine, College of Medicine, University of Florida, Gainesville, Florida. Ms. Han is an undergraduate student, Department of Statistics, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida. Dr. Cottler is dean's professor and chair, Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida.

出版信息

Acad Med. 2014 Jul;89(7):1018-23. doi: 10.1097/ACM.0000000000000278.

DOI:10.1097/ACM.0000000000000278

PMID:24979169

Abstract

PROBLEM

Teaching hospital multidisciplinary work rounds are often inefficient, delaying the completion of patient care tasks and detracting from teaching. Participants often act as working groups rather than interdependent teams. Athletic principles were used to train multidisciplinary rounding teams to adopt the systems used by manufacturing to improve the efficiency and quality of patient care, as well as teamwork and didactic teaching.

APPROACH

Experimental groups of general medical rounding teams-faculty member, house staff, medical students, bedside nurses, pharmacists, and a case manager-were introduced to individual job descriptions (playbooks), key customer-supplier relation ships, and efficient communication protocols, accompanied by weekly feed back (game films). A two-phase pilot 11-month prospective trial (February to July 2009 and September 2011 to January 2012) compared the experimental and control rounding teams on the basis of length of stay, 30-day readmission rates, and physician, student, and patient satisfaction.

OUTCOMES

These interventions resulted in a 30% reduction in 30-day readmissions and, in the 2011-2012 phase, an 18% shorter length of stay. Anonymous surveys documented greater satisfaction of faculty, residents, and medical students, and student ratings of teaching were markedly improved. Patient satisfaction did not change.

NEXT STEPS

The new rounding system has the potential to reduce waste and improve the quality of patient care while improving caregiver satisfaction and medical student teaching. Adaptive leadership skills will be required to overcome resistance to change. The use of athletic analogies can improve teamwork and facilitate the adoption of a systems approach to the delivery of patient care.

摘要

问题

教学医院的多学科工作查房通常效率低下，延误了患者护理任务的完成，并影响了教学。参与者通常表现为工作组，而不是相互依存的团队。运用运动原则来培训多学科查房团队，使其采用制造业用于提高患者护理效率和质量以及团队合作和教学的系统。

方法

介绍给一般医疗查房团队的实验组 - 教员、住院医师、医学生、床边护士、药剂师和病例经理 - 个人工作描述（剧本）、关键的客户-供应商关系以及高效沟通协议，并每周提供反馈（游戏电影）。一项为期 11 个月的前瞻性试验（2009 年 2 月至 7 月和 2011 年 9 月至 2012 年 1 月），在基于住院时间、30 天再入院率和医生、学生和患者满意度的基础上，将实验组和对照组的查房团队进行了比较。