Department of Pediatrics (R Osborn, E Bullis, AM Fenick, E Powers, S Banker, and A Asnes), Yale University, New Haven, Conn; Department of Pediatrics and Communicable Diseases (R Osborn), University of Michigan, Ann Arbor.
Department of Pediatrics (R Osborn, E Bullis, AM Fenick, E Powers, S Banker, and A Asnes), Yale University, New Haven, Conn; Tufts University School of Medicine (E Bullis), Boston, Mass.
Acad Pediatr. 2019 Jul;19(5):489-494. doi: 10.1016/j.acap.2019.05.001. Epub 2019 May 9.
Many internal medicine residency programs have transitioned to an X + Y clinic schedule, in which weekly continuity clinics are removed and clinic experience is instead condensed into 2-week blocks interspersed throughout the year, but few pediatric training programs have adopted this approach. We initiated X + Y scheduling in the 2015 academic year, with the hypothesis that outpatient continuity could be maintained or improved while inpatient handoffs would be reduced. We also hypothesized that learner experience with X + Y scheduling would be positive.
Continuity and handoffs were compared over a 7-month period in 2013 to 2014 and 2015 to 2016. Outpatient continuity was calculated as the proportion of visits in which the patient was seen by the designated primary care provider (PCP). Handoffs were calculated through analysis of the online resident schedule with comparison of weekly totals for all inpatient teams. Resident perceptions were obtained in an online survey of residents who experienced both systems.
With X + Y scheduling, overall outpatient continuity improved from 2914 of 9882 (29.5%) of visits seen by a patient's PCP to 3066 of 9769 (31.4%) (P = .004), but preventive visit continuity decreased from 2170 of 4687 (46.2%) to 2025 of 4709 (43%) (P = .001). Inpatient handoffs decreased with X + Y scheduling from 30 to 20 weekly handoffs (P < .001). In total, 85% of residents reported a positive experience with X + Y scheduling.
An X + Y scheduling approach in pediatrics is a viable alternative to weekly clinics, resulting in improved learner experience, reductions in inpatient handoffs, and small mixed effects on outpatient continuity.
许多内科住院医师培训计划已经过渡到 X+Y 门诊排班模式，即每周的连续性门诊被取消，而门诊经验则被浓缩为 2 周的模块，分布在全年中，但很少有儿科培训计划采用这种方法。我们在 2015 学年开始采用 X+Y 排班，假设在减少住院交接的同时可以维持或提高门诊连续性。我们还假设学习者对 X+Y 排班的体验是积极的。
在 2013 年至 2014 年和 2015 年至 2016 年的 7 个月期间，对连续性和交接情况进行了比较。门诊连续性通过计算指定初级保健提供者（PCP）看诊的就诊比例来评估。交接通过分析在线住院医师排班并比较所有住院团队的每周总数来计算。通过对经历过这两种系统的住院医师进行在线调查，获得了住院医师的看法。
采用 X+Y 排班后，总体门诊连续性从 9882 次就诊中的 2954 次（29.5%）由患者的 PCP 看诊提高到 9769 次就诊中的 3066 次（31.4%）（P=0.004），但预防性就诊连续性从 4687 次就诊中的 2170 次（46.2%）降至 4709 次就诊中的 2025 次（43%）（P=0.001）。采用 X+Y 排班后，住院交接从 30 次减少到 20 次（P<0.001）。总的来说，85%的住院医师报告对 X+Y 排班有积极的体验。
儿科的 X+Y 排班模式是替代每周门诊的可行方法，可提高学习者的体验，减少住院交接，对门诊连续性的影响较小。
