Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Netw Open. 2022 Jun 1;5(6):e2215885. doi: 10.1001/jamanetworkopen.2022.15885.
The patient-physician clinical encounter is the cornerstone of medical training, yet residents spend as little as 12% of their time in direct patient contact.
To use a real-time locating system (RTLS) to characterize intern work experiences in the hospital, understand factors associated with time spent at patients' bedsides, and inform future interventions to increase time spent with patients.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from July 1, 2018, to June 30, 2019 (ie, the academic year 2018-2019). Internal medicine residents from postgraduate year 1 (interns) at an academic medical center wore an infrared badge that recorded location and duration (eg, patient room, ward hall, physician workroom). Data were analyzed from September 1, 2020, to August 30, 2021.
Main outcome was time (in minutes) at the bedside; the unit of analysis was a 24-hour intern day or interval of time within the day (eg, rounding period). Descriptive statistics are reported overall, by intern, and for 5 clinical service categories. Multilevel modeling assessed the association of intern, service, and calendar time with time spent at the bedside.
Data from 43 of 52 interns (82.7%) encompassing 95 275 hours of observations were included for analyses. Twenty-six interns (60.5%) were women. Interns were detected for a mean (SD) of 722.8 (194.4) minutes per 24-hour period; 13.4% of this time was spent in patient rooms (mean [SD] time, 96.8 [57.2] minutes) and 33.3% in physician workrooms (mean [SD] time, 240.9 [228.8] minutes). Mean percentage of time at the bedside during a 24-hour period varied among interns from 8.8% to 18.3%. Mean (SD) percentage of time at the bedside varied by service for the 24-hour period from 11.7% (6.6%) for nononcology subspecialties to 15.4% (6.0%) for oncology, and during rounds from 8.0% (12.4%) for nononcology subspecialties to 26.5% (12.1%) for oncology. In multilevel modeling, the individual intern accounted for 8.1% of overall variance in time spent at the bedside during a 24-hour period, and service accounted for 18.0% of variance during rounds.
The findings of this cross-sectional study support previous evidence suggesting that interns spend only a small proportion of time with hospitalized patients. The differences in time spent in patients' rooms among interns and during rounds constitute an opportunity to design interventions that bring trainees back to the bedside.
医患临床接触是医学培训的基石，但住院医师的实际工作时间只有 12%左右直接与患者接触。
利用实时定位系统（RTLS）描述住院医师在医院的工作经历，了解与床边时间相关的因素，并为未来增加与患者接触的干预措施提供信息。
设计、地点和参与者：这是一项横断面研究，于 2018 年 7 月 1 日至 2019 年 6 月 30 日（即 2018-2019 学年）进行。在学术医疗中心，一年级住院医师（住院医师）佩戴一个红外徽章，记录位置和持续时间（如病房、病房大厅、医生工作室）。数据分析于 2020 年 9 月 1 日至 2021 年 8 月 30 日进行。
主要结果是床边时间（以分钟计）；分析单位为 24 小时住院医师日或当天的时间间隔（如查房时间）。报告了总体情况、住院医师和服务类别的描述性统计数据。多水平模型评估了住院医师、服务和日历时间与床边时间的关联。
共纳入 43 名（82.7%）住院医师的数据，涵盖了 95275 小时的观察时间。26 名住院医师（60.5%）为女性。住院医师平均（SD）每 24 小时检测到 722.8（194.4）分钟；其中 13.4%的时间在病房（平均[SD]时间为 96.8[57.2]分钟），33.3%在医生工作室（平均[SD]时间为 240.9[228.8]分钟）。在 24 小时期间，床边时间的平均百分比在住院医师之间从 8.8%到 18.3%不等。在 24 小时期间，床边时间的平均（SD）百分比因服务而异，非肿瘤专业为 11.7%（6.6%），肿瘤学为 15.4%（6.0%），在查房期间，非肿瘤专业为 8.0%（12.4%），肿瘤学为 26.5%（12.1%）。在多水平模型中，个人住院医师占床边时间总方差的 8.1%，服务占查房时间方差的 18.0%。
这项横断面研究的结果支持了先前的证据，即住院医师只有一小部分时间与住院患者在一起。住院医师在病房和查房期间在患者床边的时间差异为设计将受训者带回床边的干预措施提供了机会。
