儿科住院医师对夜间轮班制与 24 小时制的看法：一项前瞻性研究。

Pediatric resident's perception of night float system compared to 24 hours system, a prospective study.

机构信息

College of Medicine, King Saud University, P.O. 231418, Riyadh, Riyadh, 11321, Saudi Arabia.

Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia.

出版信息

BMC Med Educ. 2021 Jan 6;21(1):23. doi: 10.1186/s12909-020-02474-x.

DOI:10.1186/s12909-020-02474-x

PMID:33407360

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7789422/

Abstract

BACKGROUND

The study aims to evaluate the perceptions of pediatric residents under the night float (NF) on-call system and its impact on well-being, education, and patient safety compared with the traditional 24-h on-call system.

METHODS

The study is prospective in nature and conducted on two pediatric resident training centers who apply the NF on-call system as a pilot project. Senior residents (PGY-3 and PGY-4) enrolled in the two training centers were invited to participate before and 6 months after the implementation of the change in the on-call system. A self-administered online questionnaire was distributed. Responses were rated using a five-point Likert-type scale (1 = strongly disagree; 5 = strongly agree). The items covered three main domains, namely, residents' well-being, ability to deliver healthcare, and medical education experience. Pre- and post-intervention scores were presented as means and compared by t-test for paired samples.

RESULTS

A total of 42 residents participated in the survey (female = 24; 57.1%). All participants were senior residents; 25 (59.6%) were third-year residents (PGY-3), whereas 17 (40.4%) were fourth-year residents (PGY-4). The participants reported that many aspects of the three domains were improved with the introduction of the NF system. The system was perceived to exert less adverse health effect on the residents (mean: 2.37 ± 1.01) compared with the 24-h on-call system (mean: 4.19 ± 0.60; P < 0.001). In addition, the NF system was perceived to lead to less exposure to personal harm and result in less negative impact on quality of care, better work efficiency, reduced potential for medical errors, more successful teaching, and less disruptions to other rotations compared with the 24 h on-call system (P < 0.001).

CONCLUSION

The perception of senior residents toward the 24-h on-call system pertains to negative impacts on well-being, education, and patient safety compared with on-call systems with restrictive duty hours, such as the NF system, which is perceived to be less harmful, to exert positive impacts on the quality of delivered healthcare services, and more useful from pedagogic aspect.

摘要

背景

本研究旨在评估儿科住院医师对夜间轮岗（NF）值班系统的看法，以及与传统 24 小时值班系统相比，该系统对幸福感、教育和患者安全的影响。

方法

本研究为前瞻性研究，在两个应用 NF 值班系统的儿科住院医师培训中心进行。邀请在这两个培训中心注册的高年级住院医师（PGY-3 和 PGY-4）在值班系统变更前和变更后 6 个月参加。发放了一份自我管理的在线问卷。使用五点李克特量表（1=强烈不同意；5=强烈同意）对回答进行评分。项目涵盖三个主要领域，即居民的幸福感、提供医疗保健的能力和医学教育经验。干预前后的评分均以均值表示，并通过配对样本 t 检验进行比较。

结果

共有 42 名住院医师参与了调查（女性=24；57.1%）。所有参与者均为高年级住院医师；25 名（59.6%）为三年级住院医师（PGY-3），17 名（40.4%）为四年级住院医师（PGY-4）。参与者报告说，引入 NF 系统改善了三个领域的许多方面。与 24 小时值班系统相比（均值：4.19 ± 0.60；P < 0.001），该系统对居民的健康影响较小（均值：2.37 ± 1.01）。此外，与 24 小时值班系统相比，NF 系统被认为导致较少的人身伤害，对护理质量的负面影响较小，工作效率更高，医疗错误的潜在风险更小，教学更成功，对其他轮班的干扰更小（P < 0.001）。