van Gils-van Rooij Elisabeth Sybilla Johanna, Broekman Sjoerd Michael, de Bakker Dingenus Herman, Meijboom Berthold Rudy, Yzermans Christoffel Joris
Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands.
GP co-operative Zuidoost Brabant, Eindhoven, The Netherlands.
BMC Health Serv Res. 2018 Feb 17;18(1):121. doi: 10.1186/s12913-018-2919-y.
In an attempt to redirect patients who are inappropriately attending hospital emergency departments (ED) and in doing so provide the right care at the right place, out-of-hours GP (General Practitioner) services and EDs increasingly collaborate in Urgent Care Collaborations (UCCs). Work satisfaction is an important factor in analysing the impact of this organisational change. The objective of this study is, firstly, to discover if there is a difference in the employee experiences between those working in UCCs and those in traditional out-of-hours services in which EDs and out-of-hours GP services operate separately (i.e. "usual care"). Secondly, we would like to identify which factors affect employees' experiences in these settings.
This study followed a cross-sectional study design, comparing usual care with UCCs. Data regarding employee experiences were collected from physicians, nurses, nurse practitioners, medical assistants and front desk personnel, by means of a questionnaire with scales regarding quality, workload and co-operation between the out-of-hours GP service and ED. Independent samples t-tests were used to determine mean differences between the settings. Multiple linear regression analyses were performed to test which items affected the perceived quality, workload and co-operation.
The results showed that mutual co-operation alone was perceived as significantly better in UCCs compared to usual care. If divided between employers, no differences were found in the employee experiences working in out-of-hours GP services. ED employees in UCCs experienced a significantly better co-operation with their GP colleagues than their peers in the usual care setting, but also a higher workload. Remarkably, ED employees were less satisfied in general. The multiple regression model showed that perceived quality, workload and co-operation were interrelated. Co-operation was the only aspect that was rated higher in the UCC setting.
While perceived quality is equal and co-operation between out-of-hours GP service and ED is better, the objective and perceived ED workload was higher in UCCs compared to usual care. Though UCCs relieve the pressure on EDs concerning the number of patients, they seem to aggravate the workload. EDs need to be careful not to excessively adjust staff capacity when responding to lower numbers of patients.
为了引导那些不恰当前往医院急诊科（ED）就诊的患者，并在合适的地点提供恰当的护理，非工作时间全科医生（GP）服务与急诊科越来越多地在紧急护理协作（UCC）中展开合作。工作满意度是分析这种组织变革影响的一个重要因素。本研究的目的，首先是要发现参与紧急护理协作的员工与在传统非工作时间服务（即急诊科和非工作时间全科医生服务各自独立运作，即“常规护理”）中工作的员工在工作体验上是否存在差异。其次，我们希望确定哪些因素会影响这些环境中员工的体验。
本研究采用横断面研究设计，将常规护理与紧急护理协作进行比较。通过一份包含关于非工作时间全科医生服务与急诊科之间的质量、工作量和合作量表的问卷，收集医生、护士、执业护士、医疗助理和前台人员有关员工体验的数据。使用独立样本t检验来确定不同环境之间的平均差异。进行多元线性回归分析以测试哪些项目会影响感知质量、工作量和合作。
结果表明，与常规护理相比，紧急护理协作中仅相互合作被认为明显更好。如果按雇主划分，在非工作时间全科医生服务中工作的员工体验没有差异。紧急护理协作中的急诊科员工与他们的全科医生同事的合作明显比常规护理环境中的同行更好，但工作量也更高。值得注意的是，急诊科员工总体上满意度较低。多元回归模型表明，感知质量、工作量和合作是相互关联的。合作是在紧急护理协作环境中评分更高的唯一方面。
虽然感知质量相当，且非工作时间全科医生服务与急诊科之间的合作更好，但与常规护理相比，紧急护理协作中急诊科的客观和感知工作量更高。尽管紧急护理协作减轻了急诊科在患者数量方面的压力，但似乎加剧了工作量。急诊科在应对患者数量减少时，需要谨慎避免过度调整人员配置。
