Lafleur Alexandre, Harvey Adrien, Simard Caroline
Département de médecine, Faculté de médecine, Université Laval, Québec, Canada.
QMA-CMA-MD Educational Leadership Chair in Health Professions Education, Vice-décanat à la pédagogie et au développement professionnel continu, Faculté de medicine, Université Laval, Québec, Canada.
Can Med Educ J. 2018 Nov 12;9(4):e111-e119. eCollection 2018 Nov.
New scheduling models were needed to adjust to residents' duty hour reforms while maintaining safe patient care. In interdisciplinary night-float rotations, four to six residents from most residency programs collaborated for after-hours cross-coverage of most adult hospitalised patients as part of a Faculty-led rotation. Residents worked sixteen 12-hour night shifts over a month.
We measured residents' perception of the patient safety climate during implementation of night-float rotations in five tertiary hospitals. We surveyed 267 residents who had completed the rotation in 2015-2016 with an online version of the Safety Attitudes Questionnaire. First year residents came from most residency programs, second- and third-year residents came from internal medicine.
One-hundred-and-thirty residents completed the questionnaire. Scores did not differ across hospitals and residents' years of training for all six safety-related climate factors: teamwork climate, job satisfaction, perceptions of management, safety climate, working conditions, and stress recognition.
Simultaneous implementation in five hospitals of a Faculty-led interdisciplinary night-float rotation for most junior residents proved to be logistically feasible and showed similar and reassuring patient safety climate scores.
需要新的排班模式来适应住院医师值班时长改革，同时确保患者护理安全。在跨学科夜间轮值中，大多数住院医师培训项目的四至六名住院医师协作，对大多数成年住院患者进行下班后的交叉覆盖，这是由教员主导的轮值的一部分。住院医师在一个月内要值16个12小时的夜班。
我们在五家三级医院实施夜间轮值期间，测量了住院医师对患者安全氛围的看法。我们用在线版的《安全态度问卷》对267名在2015 - 2016年完成轮值的住院医师进行了调查。一年级住院医师来自大多数住院医师培训项目，二、三年级住院医师来自内科。
130名住院医师完成了问卷。在所有六个与安全相关的氛围因素方面，各医院以及不同培训年限的住院医师得分并无差异，这六个因素分别是团队合作氛围、工作满意度、对管理的看法、安全氛围、工作条件和压力认知。
事实证明，同时在五家医院为大多数初级住院医师实施由教员主导的跨学科夜间轮值在后勤方面是可行的，并且患者安全氛围得分相似且令人安心。
