Department of General Surgery, 2345Medical University of South Carolina, Charleston, SC, USA.
Department of Pediatric Surgery, 14524Phoenix Children's Hospital, Phoenix, AZ, USA.
Am Surg. 2022 Jun;88(6):1181-1186. doi: 10.1177/0003134821991987. Epub 2021 Jan 31.
Communication is a keystone to good medical practice. At night, as physician numbers decrease, frequent, nonurgent interruptions have shown to disrupt patient care and impact resident/physician wellness. Potentially, interruptions can lead to an increase in medical errors. The frequency and activities interrupted during night calls have not been fully described.
For a period of 44 days (August through September), all calls and pages received during the 12-hour night call session were documented. Calls were analyzed by caller, urgency, need for intervention, and resident interrupted by the communication.
A total of 494 communications were identified with a mean of 10 calls per shift (IQR 7-14). Communications lasted a mean of 2.7 +/- 2.9 minutes. Direct calls occurred in 78% and pages in 22% of the cases. From the non-ED calls (n = 335), most of them came from nursing staff (85%), followed by other specialties (12%). Five percent of the calls were directed to the wrong service. Communications occurred during charting (41%), patient assessment (33%), interrupted resident's sleep (12%), or during a surgical procedure (6%). Communication required no action in 47% of the cases. A physician order was needed in 41%, while bedside clinical assessment was required in 12% of the calls.
Communications are common at night, but most did not require clinical assessment. A large portion of communications interrupted direct patient care. An opportunity exists to eliminate nonproductive communications and improve the quality of medical education.
沟通是良好医疗实践的关键。夜间，随着医生人数的减少，频繁的非紧急中断已被证明会扰乱患者护理并影响住院医师/医生的健康。潜在地，中断可能会导致医疗错误增加。夜间呼叫期间的中断频率和活动尚未得到充分描述。
在 44 天（8 月至 9 月）的时间内，记录了 12 小时夜间呼叫期间收到的所有呼叫和页面。根据呼叫者、紧急程度、干预需求以及被通信中断的住院医师，对呼叫进行了分析。
共确定了 494 次通信，平均每次轮班有 10 次呼叫（IQR 7-14）。通信持续时间平均为 2.7 +/- 2.9 分钟。直接呼叫发生在 78%的情况下，页面在 22%的情况下发生。在非 ED 呼叫（n = 335）中，大多数来自护士（85%），其次是其他专业（12%）。5%的呼叫被定向到错误的服务。通信发生在图表记录（41%）、患者评估（33%）、中断住院医师睡眠（12%）或手术过程中（6%）。47%的情况下不需要采取行动，41%的情况下需要医生下医嘱，12%的情况下需要床边临床评估。
夜间通信很常见，但大多数不需要临床评估。很大一部分通信中断了直接的患者护理。有机会消除非生产性通信并提高医学教育质量。
