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结构化的跨学科床边查房可提高住院内科病房住院医师和护士之间的专业间沟通和工作场所效率。

Structured interdisciplinary bedside rounds improve interprofessional communication and workplace efficiency among residents and nurses on an inpatient internal medicine unit.

机构信息

Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.

Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, USA.

出版信息

J Interprof Care. 2024 May-Jun;38(3):427-434. doi: 10.1080/13561820.2020.1863932. Epub 2021 Jan 12.

DOI:10.1080/13561820.2020.1863932
PMID:33433262
Abstract

Structured Interdisciplinary Bedside Rounds (SIBR) is a standardized, team-based intervention for hospitals to deliver high quality interprofessional care. Despite its potential for improving IPC and the workplace environment, relatively little is known about SIBR's effect on these outcomes. Our study aimed to assess the fidelity of SIBR implementation on an inpatient medicine teaching unit and its effects on perceived IPC and workplace efficiency. We conducted a quasi-experimental study with 88 residents and 44 nurses at a large academic medical center and observed 1308 SIBR encounters over 24 weeks. Of these 1308 encounters, the bedside nurse was present for 96.7%, physician for 97.6%, and care manager for 94.7, and 64.7% occurred at the bedside. Following SIBR implementation, perceived IPC improved significantly among residents (93.3% versus 67.9%, < .024) and nurses (73.7% versus 36.0%, < .008) compared to before implementation. Moreover, residents perceived greater workplace efficiency operationalized as being paged less frequently with questions by nurses (20.0% versus 49.1%, = .01). No statistically significant improvements were reported regarding burnout, meaning at work, and workplace satisfaction. Our implementation of SIBR significantly improved perceived IPC and workplace efficiency, which are two important domains of healthcare quality. Future work should examine the impact of SIBR on patient-centered outcomes such as patient experience.

摘要

结构化跨学科床边查房(SIBR)是一种标准化的、以团队为基础的干预措施,旨在为医院提供高质量的跨专业护理。尽管它有可能改善IPC 和工作场所环境,但对 SIBR 对这些结果的影响知之甚少。我们的研究旨在评估 SIBR 在住院内科教学单元中的实施保真度及其对感知 IPC 和工作场所效率的影响。我们在一家大型学术医疗中心进行了一项准实验研究,涉及 88 名住院医师和 44 名护士,并在 24 周内观察了 1308 次 SIBR 查房。在这 1308 次查房中,床边护士的参与率为 96.7%,医生为 97.6%,护理经理为 94.7%,64.7%发生在床边。实施 SIBR 后,住院医师的感知 IPC 显著改善(93.3%对 67.9%,<0.024),护士的感知 IPC 也显著改善(73.7%对 36.0%,<0.008)。此外,与实施前相比,住院医师认为工作场所效率更高,即被护士频繁呼入解决问题的频率降低(20.0%对 49.1%,=0.01)。报告称,在倦怠、工作中的意义和工作场所满意度方面没有统计学意义上的改善。我们对 SIBR 的实施显著改善了感知 IPC 和工作场所效率,这是医疗保健质量的两个重要领域。未来的工作应该研究 SIBR 对以患者为中心的结果(如患者体验)的影响。

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