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.
Acad Med. 2014 Jul;89(7):1018-23. doi: 10.1097/ACM.0000000000000278.
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.
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.
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.
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.
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。
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。
这些干预措施导致 30 天再入院率降低了 30%，在 2011-2012 阶段，住院时间缩短了 18%。匿名调查记录了教师、住院医师和医学生的满意度显著提高，学生对教学的评价也有了明显改善。患者满意度没有变化。
新的查房系统有可能在提高患者护理质量的同时减少浪费，提高护理人员满意度和医学生教学。需要适应性领导技能来克服对变革的抵制。运用运动类比可以提高团队合作能力，并促进采用系统方法来提供患者护理。
