Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
Value Institute, Christiana Care Health System, Newark, Delaware.
Clin J Am Soc Nephrol. 2020 Apr 7;15(4):474-483. doi: 10.2215/CJN.10190819. Epub 2020 Mar 17.
Hospital rounds are a traditional vehicle for patient-care delivery and experiential learning for trainees. We aimed to characterize practices and perceptions of rounds in United States nephrology training programs.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a national survey of United States nephrology fellows and program directors. Fellows received the survey after completing the 2019 National Board of Medical Examiners Nephrology In-Training Exam. Program directors received the survey at the American Society of Nephrology's 2019 Nephrology Training Program Directors' Retreat. Surveys assessed the structure and perceptions of rounds, focusing on workload, workflow, value for patient care, and fellows' clinical skill-building. Directors were queried about their expectations for fellow prerounds and efficiency of rounds. Responses were quantified by proportions.
Fellow and program director response rates were 73% (=621) and 70% (=55). Most fellows (74%) report a patient census of >15, arrive at the hospital before 7:00 am (59%), and complete progress notes after 5:00 pm (46%). Among several rounding activities, fellows most valued bedside discussions for building their clinical skills (34%), but only 30% examine all patients with the attending at the bedside. Most directors (71%) expect fellows to both examine patients and collect data before attending-rounds. A majority (78%) of directors commonly complete their documentation after 5:00 pm, and for 36%, after 8:00 pm. Like fellows, directors most value bedside discussion for development of fellows' clinical skills (44%). Lack of preparedness for the rigors of nephrology fellowship was the most-cited barrier to efficient rounds (31%).
Hospital rounds in United States nephrology training programs are characterized by high patient volumes, early-morning starts, and late-evening clinical documentation. Fellows use a variety of prerounding styles and examine patients at the beside with their attendings at different frequencies.
This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_17_CJN.10190819.mp3.
医院查房是为住院患者提供医疗服务和为实习生提供经验学习的传统方式。我们旨在描述美国肾脏病培训项目中查房的实践和认知情况。
设计、地点、参与者和测量方法：我们对美国肾脏病住院医师和项目主任进行了一项全国性调查。住院医师在完成 2019 年美国国家医师考试委员会肾脏病住院医师考试后收到了该调查。项目主任在 2019 年美国肾脏病学会肾脏病培训项目主任研讨会上收到了该调查。调查评估了查房的结构和认知，重点关注工作量、工作流程、对患者护理的价值以及住院医师的临床技能培养。主任们被问到他们对住院医师准备查房的期望以及查房效率。回应通过比例进行量化。
住院医师和项目主任的回复率分别为 73%（=621）和 70%（=55）。大多数住院医师（74%）报告患者人数超过 15 人，早上 7:00 前到达医院（59%），下午 5:00 后完成病历记录（46%）。在几种查房活动中，住院医师最重视床边讨论以建立他们的临床技能（34%），但只有 30%的人会与主治医生一起检查所有患者。大多数主任（71%）希望住院医师在参加查房前既检查患者又收集数据。大多数主任（78%）通常在下午 5:00 后完成他们的文件，而对于 36%的主任，在下午 8:00 后完成。与住院医师一样，主任们最看重床边讨论对培养住院医师临床技能的价值（44%）。缺乏准备好迎接肾脏病住院医师培训的严格要求是阻碍高效查房的最主要原因（31%）。
美国肾脏病培训项目中的医院查房以高患者量、清晨开始和深夜临床文件记录为特征。住院医师采用各种准备查房的方式，以不同的频率与主治医生一起在床边检查患者。
本文包含一个播客，可在 https://www.asn-online.org/media/podcast/CJASN/2020_03_17_CJN.10190819.mp3 上收听。
