Royal Free Hospital, Pond St, Hampstead, London, NW3 2QG, UK.
Leicester Royal Infirmary, Leicester, UK.
Ir J Med Sci. 2019 Aug;188(3):1047-1055. doi: 10.1007/s11845-018-1937-4. Epub 2018 Nov 27.
Fluid and electrolyte management for hospital inpatients has been identified by multiple reports to be suboptimal, with delegation of this task to the most junior members of a medical team, Foundation Year One (FY1) doctors, also known as interns or house officers, being identified as a contributing factor.
An online survey was distributed nationally via social media to FY1 doctors between 21st August 2018 and 19th September 2018. Questions focused around cohort characteristics, team behaviours around fluid and electrolyte prescribing, as well as teaching and knowledge.
Two hundred eighty-six doctors participated. 67.13% knew the daily water requirement of a healthy adult. 58.39 and 79.72% knew the daily requirements of potassium and sodium, respectively. 41.26 and 33.57% knew the potassium and sodium composition of Hartmann's solution (1 L), respectively, with only 31.12% of candidates knowing the correct sodium content of 1 L of normal saline 0.9%. FY1 doctors were the principle prescribers of fluid therapy (97.55%); senior house officers, registrars, and consultants were only actively involved in the process 51.75, 20.98, and 5.59% of the time, respectively. 30.77 and 23.43% of FY1s received guidelines and/or teaching on the topic within their firms or as part of their foundation teaching, respectively. At undergraduate level, 52.44% of doctors reported the teaching to be "neither poor or good," "poor," or "very poor."
The principle knowledge base underlying fluid and electrolyte management is still poorly understood by FY1 doctors, with poor teaching of the subject at both undergraduate and post-graduate level potentially contributing.
多项报告表明，医院住院患者的液体和电解质管理并不理想，将这项任务委托给医疗团队中最年轻的成员——即第一年住院医师（Foundation Year One，FY1）医生，也被认为是造成这种情况的一个因素。
2018 年 8 月 21 日至 9 月 19 日期间，通过社交媒体向 FY1 医生在全国范围内分发了在线调查。问题集中在队列特征、液体和电解质处方方面的团队行为以及教学和知识方面。
共有 286 名医生参与了调查。67.13%的医生知道健康成年人的日常需水量。58.39%和 79.72%的医生分别知道钾和钠的日常需求量。分别只有 41.26%和 33.57%的医生知道哈特曼溶液（1L）的钾和钠组成，只有 31.12%的医生知道 1L 生理盐水的正确钠含量为 0.9%。FY1 医生是液体治疗的主要处方医生（97.55%）；高级住院医师、注册医师和顾问仅在 51.75%、20.98%和 5.59%的时间内积极参与该过程。分别有 30.77%和 23.43%的 FY1 医生在其所在公司或作为其基础教学的一部分接受了该主题的指南和/或教学。在本科阶段，52.44%的医生报告教学“既不差也不好”、“差”或“非常差”。
FY1 医生对液体和电解质管理的主要基础知识仍了解甚少，本科和研究生阶段教学质量差可能也是造成这种情况的原因之一。
