Univeristy of Nebraska Medical Center, Department of Otolaryngology Head and Neck Surgery, 981225 Nebraska Medical Center, Omaha, NE,USA.
Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE USA.
Hosp Pract (1995). 2022 Apr;50(2):124-131. doi: 10.1080/21548331.2022.2050649. Epub 2022 Mar 14.
To describe the structure and implementation of a model in which hospitalists focus on a particular hospital unit or area, referred to as 'geographic rounding,' and to analyze its effect on hospitalist efficiency, interruptions, after-hours work, and satisfaction.
The leadership of our academic hospital medicine group designed a geographic rounding intervention with the goal of improving provider satisfaction and mitigating burnout. Our quantitative analysis compared the pre-intervention and post-intervention time periods with regard to progress note completion time, after-hours progress note completion, secure messaging communication volume, and Mini-Z survey results. A post-intervention qualitative analysis was performed to further explore the relationship between geographic rounding and the drivers of burnout.
Following the intervention, 97% of geographic rounders were localized to one or two geographic areas and 77% were localized to a single geographic area. Following the implementation of geographic rounding, progress notes were completed an average of 29 minutes earlier (p < 0.001). The proportion of progress notes completed after-hours decreased from 25.1% to 20% (p < 0.001). The volume of secure messages received by hospitalists decreased from 1.95 to 1.8 per patient per day (p < 0.001). The proportion of hospitalists reporting no burnout increased from 77.8% to 93% after implementing geographic rounding, a change that did not reach statistical significance (p = 0.1). Qualitative analysis revealed mixed effects on work environment but improvements in efficiency, patient-centeredness, communication with nurses, and job satisfaction.
Geographic rounding represents an organization-level change that has the potential to improve hospitalist career satisfaction.
描述一种模式的结构和实施情况，该模式中医院医生专注于特定的医院科室或区域，称为“地理轮值”，并分析其对医院医生效率、中断、工作时间外工作和满意度的影响。
我们的学术医院医学组的领导层设计了一种地理轮值干预措施，旨在提高提供者满意度并减轻倦怠。我们的定量分析比较了干预前后时间段内的进度记录完成时间、工作时间外完成进度记录、安全消息通信量和 Mini-Z 调查结果。进行了干预后的定性分析，以进一步探讨地理轮值与倦怠驱动因素之间的关系。
干预后，97%的地理轮值者本地化到一个或两个地理区域，77%的地理轮值者本地化到一个地理区域。实施地理轮值后，进度记录的完成平均提前了 29 分钟（p<0.001）。工作时间外完成进度记录的比例从 25.1%下降到 20%（p<0.001）。医院医生收到的安全消息量从每天每个患者 1.95 条减少到 1.8 条（p<0.001）。实施地理轮值后，报告没有倦怠的医院医生比例从 77.8%增加到 93%，但这一变化没有达到统计学意义（p=0.1）。定性分析显示工作环境的影响喜忧参半，但在效率、以患者为中心、与护士沟通和工作满意度方面有所改善。
地理轮值代表了一种组织层面的变革，有可能提高医院医生的职业满意度。
