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大学医院住院医生非工作时间报告的回顾性研究:时间和资历对差异率的影响。

A retrospective review of registrar out-of-hours reporting in a university hospital: the effect of time and seniority on discrepancy rates.

作者信息

Lam V, Stephenson J A

机构信息

Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, UK.

Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, UK.

出版信息

Clin Radiol. 2018 Jun;73(6):590.e9-590.e12. doi: 10.1016/j.crad.2018.01.012. Epub 2018 Feb 14.

Abstract

AIM

To assess the influence of time, intensity, and trainee seniority on radiology registrars' major and minor discrepancy rates during weekend reporting at a university teaching hospital.

MATERIALS AND METHODS

A 12-month retrospective review was performed of out-of-hours trainee provisional reports for computed tomography (CT) and magnetic resonance imaging (MRI) in a university teaching hospital. From Friday 9.00 pm to Sunday 9.00 pm, the out-of-hours service is provided by a single registrar rotating every 12 hours. A busy shift was defined as more than 24 reports issued during the shift. A senior trainee was defined as having more than 2 years' experience on the on-call rota. Reports were compared to subsequent subspecialist consultant review with all discrepancies collected. Discrepancy rates were calculated for junior/senior registrars, time of shift, and for busy/less busy shifts.

RESULTS

The total discrepancy rate was 11.1%, with a major discrepancy rate of 3%. Junior registrars had a lower total discrepancy rate (9.7% versus 12.2%, p=0.0065). Although there was no difference between major discrepancies, junior trainees made fewer minor discrepancies (7.1% versus 8.93%, p=0.03). The discrepancy rate was higher at night (12.3% versus 10.4%, p=0.0418). On a less busy shift, more discrepancies were made (12.8% versus 10%, p=0.0001).

CONCLUSION

The major discrepancy rate of trainees is low. More discrepancies are made at night, and trainee seniority does not mitigate this problem. Night shifts are less busy in comparison to day shifts, which may explain why less busy shifts appear to yield more mistakes.

摘要

目的

评估时间、强度和实习医生资历对某大学教学医院放射科住院医生周末报告期间主要和次要差异率的影响。

材料与方法

对某大学教学医院非工作时间实习医生的计算机断层扫描(CT)和磁共振成像(MRI)临时报告进行了为期12个月的回顾性研究。从周五晚上9点到周日晚上9点,非工作时间的服务由一名住院医生每12小时轮流提供。繁忙班次定义为该班次发出超过24份报告。高级实习医生定义为在值班轮值中有超过2年经验。将报告与随后的专科顾问复查进行比较,收集所有差异。计算初级/高级住院医生、轮班时间以及繁忙/不繁忙班次的差异率。

结果

总差异率为11.1%,主要差异率为3%。初级住院医生的总差异率较低(9.7%对12.2%,p = 0.0065)。虽然主要差异之间没有差异,但初级实习医生的次要差异较少(7.1%对8.93%,p = 0.03)。夜间差异率较高(12.3%对10.4%,p = 0.0418)。在不那么繁忙的班次中,差异更多(12.8%对10%,p = 0.0001)。

结论

实习医生的主要差异率较低。夜间差异更多,且实习医生资历并不能缓解这一问题。与日班相比,夜班不那么繁忙,这可能解释了为什么不那么繁忙的班次似乎会产生更多错误。

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