Kawamoto Eiji, Ito-Masui Asami, Esumi Ryo, Imai Hiroshi, Shimaoka Motomu
Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan.
Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan.
Front Med (Lausanne). 2020 Dec 3;7:606987. doi: 10.3389/fmed.2020.606987. eCollection 2020.
Numerous factors affecting the interactions between healthcare professionals in the workplace demand a comprehensive understanding if the quality of patient healthcare is to be improved. Our previous cross-sectional analysis showed that patient severity scores [i.e., Acute Physiology and Chronic Health Evaluation (APACHE) II] in the 24 h following admission positively correlated with the length of the face-to-face interactions among ICU healthcare professionals. The present study aims to address how the relationships between patient severity and interaction lengths can change over a period of time during both admission and treatment in the ICU. We retrospectively analyzed data prospectively collected between 19 February to 17 March 2016 from an open ICU in a University Hospital in Japan. We used wearable sensors to collect a spatiotemporal distribution dataset documenting the face-to-face interactions between ICU healthcare professionals, which involved 76 ICU staff members, each of whom worked for 160 h, on average, during the 4-week period of data collection. We studied the longitudinal relationships among these interactions, which occurred at the patient bedside, vis-à-vis the severity of the patient's condition [i.e., the Sequential Organ Failure Assessment (SOFA) score] assessed every 24 h. On Day 1, during which a total of 117 patients stayed in the ICU, we found statistically significant positive associations between the interaction lengths and their SOFA scores, as shown by the Spearman's correlation coefficient value (R) of 0.447 ( < 0.01). During the course of our observation from Day 1 to Day 10, the number of patients () who stayed in the ICU gradually decreased ( = 117, Day1; = 10, Day 10), as they either were discharged or died. The statistically significant positive associations of the interaction lengths with the SOFA scores disappeared from Days 2 to 6, but re-emerged on Day 7 ( = 0.620, < 0.05) and Day 8 ( = 0.625, < 0.05), then disappearing again on Days 9 and 10. Whereas all 6 SOFA sub-scores correlated well with the interaction lengths on Day 1, only a few of the sub-scores (coagulation, cardiovascular, and central nervous system scores) did so; specifically, those on Days 7 and 8. The results suggest that patient severity may play an important role in affecting the interactions between ICU healthcare professionals in a time-related manner on ICU Day 1 and on Days 7/8.
如果要提高患者医疗保健的质量，就需要全面了解众多影响职场中医护人员互动的因素。我们之前的横断面分析表明，入院后24小时内的患者严重程度评分[即急性生理与慢性健康状况评估（APACHE）II]与重症监护病房（ICU）医护人员面对面互动的时长呈正相关。本研究旨在探讨在ICU住院和治疗期间，患者严重程度与互动时长之间的关系如何随时间变化。我们回顾性分析了2016年2月19日至3月17日期间从日本一家大学医院的开放式ICU前瞻性收集的数据。我们使用可穿戴传感器收集了一个时空分布数据集，记录了ICU医护人员之间的面对面互动情况，该数据集涉及76名ICU工作人员，在为期4周的数据收集期间，每人平均工作160小时。我们研究了这些在患者床边发生的互动与每24小时评估一次的患者病情严重程度[即序贯器官衰竭评估（SOFA）评分]之间的纵向关系。在第1天，共有117名患者入住ICU，我们发现互动时长与其SOFA评分之间存在统计学上显著的正相关，斯皮尔曼相关系数值（R）为0.447（<0.01）。在从第1天到第10天的观察过程中，留在ICU的患者数量（n）逐渐减少（第1天n = 117；第10天n = 10），因为他们要么出院要么死亡。互动时长与SOFA评分之间的统计学显著正相关在第2天至第6天消失，但在第7天（R = 0.620，P < 0.05）和第8天（R = 0.625，P < 0.05）再次出现，然后在第9天和第10天又消失。虽然所有6个SOFA子评分在第1天都与互动时长有很好的相关性，但只有少数子评分（凝血、心血管和中枢神经系统评分）在第7天和第8天有相关性。结果表明，在ICU第1天以及第7/8天，患者严重程度可能会以时间相关的方式在影响ICU医护人员之间的互动中发挥重要作用。
