Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN.
Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN.
Ann Surg. 2022 May 1;275(5):883-890. doi: 10.1097/SLA.0000000000005416. Epub 2022 Feb 17.
To determine whether trauma patients managed by an admitting or consulting service with a high proportion of physicians exhibiting patterns of unprofessional behaviors are at greater risk of complications or death.
Trauma care requires high-functioning interdisciplinary teams where professionalism, particularly modeling respect and communicating effectively, is essential.
This retrospective cohort study used data from 9 level I trauma centers that participated in a national trauma registry linked with data from a national database of unsolicited patient complaints. The cohort included trauma patients admitted January 1, 2012 through December 31, 2017. The exposure of interest was care by 1 or more high-risk services, defined as teams with a greater proportion of physicians with high numbers of patient complaints. The study outcome was death or complications within 30 days.
Among the 71,046 patients in the cohort, 9553 (13.4%) experienced the primary outcome of complications or death, including 1875 of 16,107 patients (11.6%) with 0 high-risk services, 3788 of 28,085 patients (13.5%) with 1 high-risk service, and 3890 of 26,854 patients (14.5%) with 2+ highrisk services (P < 0.001). In logistic regression models adjusting for relevant patient, injury, and site characteristics, patients who received care from 1 or more high-risk services were at 24.1% (95% confidence interval 17.2% to 31.3%; P < 0.001) greater risk of experiencing the primary study outcome.
Trauma patients who received care from at least 1 service with a high proportion of physicians modeling unprofessional behavior were at an increased risk of death or complications.
确定由表现出不专业行为模式的医生比例较高的收治或会诊服务管理的创伤患者是否更有可能出现并发症或死亡。
创伤护理需要高功能的跨学科团队，其中专业精神，特别是树立尊重和有效沟通，是至关重要的。
这项回顾性队列研究使用了来自 9 个参与国家创伤登记处的 1 级创伤中心的数据，这些数据与来自国家非邀约患者投诉数据库的数据相链接。队列包括 2012 年 1 月 1 日至 2017 年 12 月 31 日期间收治的创伤患者。感兴趣的暴露是由 1 个或多个高风险服务提供的护理，定义为具有较高比例医生和较高数量患者投诉的团队。研究结果是 30 天内死亡或出现并发症。
在队列中的 71046 名患者中，有 9553 名（13.4%）经历了并发症或死亡的主要结局，其中 16107 名患者中有 1875 名（11.6%）、28085 名患者中有 3788 名（13.5%）、26854 名患者中有 3890 名（14.5%）的 0 个、1 个和 2 个以上高风险服务（P<0.001）。在调整了相关患者、损伤和部位特征的逻辑回归模型中，接受 1 个或多个高风险服务治疗的患者发生主要研究结局的风险增加了 24.1%（95%置信区间 17.2%至 31.3%；P<0.001）。
至少接受 1 个表现出不专业行为模式医生比例较高的服务治疗的创伤患者，其死亡或并发症的风险增加。
