Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, and the Center for Clinical Research and Evidence Based Medicine, McGovern School at the University of Texas Health Science Center at Houston, Houston, Texas.
Obstet Gynecol. 2016 Aug;128(2):381-386. doi: 10.1097/AOG.0000000000001528.
To investigate whether delayed timing of physician rounds improves patient satisfaction for postpartum women.
Women were randomized to early (5-7 AM) or delayed (8-10 AM) physician rounding. Women with stillbirth, high-risk pregnancy, or complications precluding delayed rounding were excluded. At discharge, women completed a modified Hospital Consumer Assessment of Healthcare Providers and Systems survey. The primary outcome was rating of the hospital. Secondary outcomes included patient assessment of patient-physician communication, various hospital experiences, and timing of maternal and neonatal discharge. We estimated that 74 women were needed to detect a 20% difference in rating of the hospital (0-10 score) between groups (assumption P=.05, power 90%). Given limited information on primary outcome, an a priori plan was in place to conduct the study for 2 months.
One hundred fifty-two women were randomized (n=76 early rounding; n=76 delayed rounding). More women had a cesarean delivery in the early compared with the delayed rounding group (47.4% compared with 22.4%). Median rating of the hospital was higher in the delayed as compared with the early rounding group (9.0 [7.0-9.0] compared with 7.0 [6.0-8.0]; P<.01). Median scores regarding physician communication and perception of hospital experiences were higher in the delayed compared with the early group (8.0 [7.0-9.0] compared with 6.0 [5.0-7.0]; P<.001). Adjustment for delivery mode did not alter results (P<.01). No differences in timing of maternal (P=.47) or neonatal hospital discharge (P=.35) were observed.
Postpartum women receiving delayed physician rounding were more satisfied with their hospital experience and patient-physician communication without prolonging maternal or neonatal discharge.
ClinicalTrials.gov, https://clinicaltrials.gov, NCT02432573.
研究医师查房时间延迟是否会提高产后女性的满意度。
将女性随机分为早班(5-7 点)和晚班(8-10 点)查房。排除死产、高危妊娠或妨碍延迟查房的并发症的女性。出院时,女性完成了一项经改良的医疗机构患者体验调查(HCAHPS)。主要结局是对医院的评价。次要结局包括患者对医患沟通、各种医院体验以及母婴出院时间的评估。我们估计需要 74 名女性才能检测到组间(假设 P=.05,效能 90%)医院评价(0-10 分)的 20%差异。鉴于主要结局的信息有限,我们预先计划进行为期 2 个月的研究。
共有 152 名女性被随机分配(早班 76 名,晚班 76 名)。与晚班相比,早班行剖宫产的女性更多(47.4%比 22.4%)。与早班相比,晚班的医院评价中位数更高(9.0[7.0-9.0]比 7.0[6.0-8.0];P<.01)。在延迟组中,关于医生沟通和对医院体验的感知的评分中位数也高于早班组(8.0[7.0-9.0]比 6.0[5.0-7.0];P<.001)。调整分娩方式后,结果没有改变(P<.01)。母亲(P=.47)或新生儿(P=.35)出院时间没有差异。
接受延迟查房的产后女性对其住院体验和医患沟通更满意,而不会延长母婴的出院时间。
ClinicalTrials.gov,https://clinicaltrials.gov,NCT02432573。