采用时间运动观测对内科住院医师工作时间分配的医院间比较：一种创新的基准工具。

Inter-hospital comparison of working time allocation among internal medicine residents using time-motion observations: an innovative benchmarking tool.

机构信息

Department of Cardiology, University Hospital Basel, Basel, Switzerland

Department of Internal Medicine, Kantonsspital Baden, Baden, Switzerland.

出版信息

BMJ Open. 2020 Feb 16;10(2):e033021. doi: 10.1136/bmjopen-2019-033021.

DOI:10.1136/bmjopen-2019-033021

PMID:32066604

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7044966/

Abstract

OBJECTIVES

The vast majority of residents' working time is spent away from patients. In hospital practice, many factors may influence the resident's working day structure.Using an innovative method, we aimed to compare working time allocation among internal medicine residents using time-motion observations. The first study goal was to describe how the method could be used for inter-hospital comparison. The secondary goal was to learn about specific differences in the resident's working day structure in university and non-university hospital settings.

DESIGN

Two separate time-motion studies. Trained peer-observers followed the residents during weekday day shifts with a tablet, able to record 22 different activities and corresponding context (with patient, phone, colleague or computer).

SETTING

Internal medicine residencies at a university (May-July 2015) and a non-university (September-October 2016) community hospital.

PARTICIPANTS

28 residents (mean age: 29 years, average postgraduate training: 30 months) at university hospital, 21 residents (mean age: 30 years, average postgraduate training: 17 months) at non-university hospital.

OUTCOMES

Time spent with patients and time dedicated to activities directly related to patients; description of main differences of time allocation between hospitals.

RESULTS

Cumulatively 1051 hours of observation (566 (university hospital)+486 (non-university hospital)) and 92 day shifts (49+43) were evaluated. Daily working time was 11.5 versus 11.3 hours. A median daily period of 195 min (IQR 179-211, 27.9%) and 116 min (IQR 98-134, 17.2%) (p<0.001) was dedicated to direct patient care, respectively.

CONCLUSIONS

We successfully identified differences potentially related to each hospital structure and organisation. Inter-hospital comparisons could help set up interventions aiming to improve workday structure and experience of residents.

摘要

目的

住院医师的大部分工作时间都不在患者身边。在医院实践中，许多因素可能会影响住院医师的工作日结构。我们采用一种创新的方法，通过时间动作观察来比较内科住院医师的工作时间分配。第一个研究目标是描述如何将该方法用于医院间比较。次要目标是了解大学医院和非大学医院环境中住院医师工作日结构的具体差异。

设计

两项独立的时间动作研究。经过培训的同行观察员使用平板电脑在工作日白天跟随住院医师，能够记录 22 种不同的活动及其相应的背景（与患者、电话、同事或计算机有关）。

地点

大学（2015 年 5 月至 7 月）和非大学（2016 年 9 月至 10 月）社区医院的内科住院医师培训计划。

参与者

大学医院 28 名住院医师（平均年龄：29 岁，研究生培训平均时长：30 个月），非大学医院 21 名住院医师（平均年龄：30 岁，研究生培训平均时长：17 个月）。

结果

观察到的与患者在一起的时间和专门用于与患者直接相关的活动的时间；描述医院之间时间分配的主要差异。

结果

共观察 1051 小时（566 小时[大学医院]+486 小时[非大学医院]）和 92 个工作日（49 个+43 个）。每天工作时间为 11.5 小时对 11.3 小时。分别有中位数每天 195 分钟（IQR 179-211，27.9%）和 116 分钟（IQR 98-134，17.2%）（p<0.001）专门用于直接的患者护理。