Shirreff Lindsay, Husslein Heinrich, Lefebvre Guylaine G, Shore Eliane M
Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON.
Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria.
J Obstet Gynaecol Can. 2019 Aug;41(8):1108-1114. doi: 10.1016/j.jogc.2018.11.004. Epub 2019 Jan 25.
This study sought to determine whether physician-nurse bedside rounds and ward task list improve quality of care as measured by patient satisfaction, earlier discharge, and reduced trainee interruptions.
This prospective, single-blind, pre- and post-intervention study included patients admitted to the gynaecology ward at St. Michael's Hospital in Toronto, Ontario, involving a 6-week baseline, 6-week intervention, and 2-week second baseline phase. During the intervention phase, a chief resident and charge nurse rounded at the bedside simultaneously daily. Nurses recorded non-urgent issues on a ward task list. Patients completed a subset of the National Research Corporation Picker satisfaction questionnaire, discharge times were noted, and residents recorded pages (Canadian Task Force Classification II-2).
There were 89, 104, and 30 admissions during baseline care, intervention, and second baseline phases, respectively. Mean discharge time in the intervention phase was significantly earlier than baseline (11:18 am ± 1 hour 59 minutes vs. 12:37 pm ± 2 hours 37 minutes, P < 0.001), with early discharges doubling (69% vs. 36%, P < 0.001). Discharge times returned to baseline after the intervention (12:36 pm ± 2 hours 39 minutes). Intervention phase patients appreciated bedside care plans (86 of 94 patients, 92%), with improved National Research Corporation Picker responses, which diminished post-intervention. Paging interruptions were lower during the intervention phase compared with the baseline phase (1.0 ± 1.1 vs. 3.4 ± 2.1, P < 0.001), with non-urgent pages decreasing most (0.5 ± 0.8 vs. 3.0 ± 2.0, P < 0.001).
Combining physician-nurse bedside rounds and ward task list reduces trainee interruptions, positively affects patient satisfaction, and promotes early discharge. Following these initiatives, discharge time, patient satisfaction, and resident paging interruptions returned to baseline.
本研究旨在确定医生 - 护士床边查房和病房任务清单是否能提高护理质量，护理质量通过患者满意度、提前出院和减少实习医生被打断的次数来衡量。
这项前瞻性、单盲、干预前后对照研究纳入了安大略省多伦多市圣迈克尔医院妇科病房的患者，包括为期6周的基线期、6周的干预期和2周的第二个基线期。在干预期，一名总住院医师和责任护士每天同时进行床边查房。护士在病房任务清单上记录非紧急问题。患者完成了国家研究公司Picker满意度调查问卷的一个子集，记录了出院时间，住院医师记录了传呼次数（加拿大工作组分类II - 2）。
在基线护理期、干预期和第二个基线期分别有89例、104例和30例入院患者。干预期的平均出院时间显著早于基线期（上午11:18 ± 1小时59分钟 vs. 下午12:37 ± 2小时37分钟，P < 0.001），提前出院的比例翻倍（69% vs. 36%，P < 0.001）。干预后出院时间恢复到基线水平（下午12:36 ± 2小时39分钟）。干预期患者对床边护理计划表示满意（94例患者中的86例，92%），国家研究公司Picker问卷的反馈有所改善，但干预后有所下降。与基线期相比，干预期传呼打断次数更低（1.0 ± 1.1 vs. 3.4 ± 2.1，P < 0.001），非紧急传呼减少最多（0.5 ± 0.8 vs. 3.0 ± 2.0，P < 0.001）。
医生 - 护士床边查房与病房任务清单相结合可减少实习医生被打断的次数，对患者满意度产生积极影响，并促进提前出院。实施这些举措后，出院时间、患者满意度和住院医师传呼打断次数恢复到基线水平。
