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创建全面的大流行应对措施以减少 COVID-19 期间医院医生的倦怠:在 2 家可比医院(HOSP-CPR)中进行干预与对照的结果。

Creating a Comprehensive Pandemic Response to Decrease Hospitalist Burnout During COVID-19: Intervention vs Control Results in 2 Comparable Hospitals (HOSP-CPR).

机构信息

Department of Medical Education, Providence Portland Medical Center, 5050 NE Hoyt Suite 540, Portland, OR, 97213, USA.

Department of Hospital Medicine, Providence Portland Medical Center, Portland, OR, USA.

出版信息

J Gen Intern Med. 2023 Apr;38(5):1256-1263. doi: 10.1007/s11606-023-08041-6. Epub 2023 Feb 10.

Abstract

BACKGROUND

Physician burnout increased during the COVID-19 pandemic.

OBJECTIVE

To evaluate the effectiveness of a multimodal workplace intervention designed to reduce hospitalist burnout.

DESIGN

Participants and setting: Our intervention group was composed of internal medicine hospitalists at Providence Portland Medical Center (64 providers including 58 physicians and 6 nurse practitioners). Our control was composed of internal medicine hospitalists at Providence St Vincent's Hospital (59 physicians and 6 nurse practitioners).

MEASUREMENTS

Two surveys were given during, before, and after a 12-month intervention period (October 2020 and again in October 2021). Surveys included demographics, job satisfaction, the Maslach Burnout Inventory, the Pandemic Experiences Survey, and 2 questions about leaving the job.

INTERVENTIONS

Three hospitalists designated as wellness warriors created weekly COVID group meetings, providing up-to-date information about COVID-19 infection rates, treatments, and work-flow changes. Discussions included coping and vaccine hesitancy, difficult case debriefs, and intensive care unit updates. Individual coaching was also offered. Meeting minutes were taken and sessions were recorded for asynchronous access.

RESULTS

No site differences in burnout or job satisfaction were evident pre-intervention. Post-intervention, the intervention group reported 32% burnout while controls reported 56% (p = .024). Forty-eight percent of the intervention group reported high wellness support vs. 0% of the controls (< .001). Intervention participants attributed 44% of wellness support to Providence alone, vs. controls at 12% (< .001). Regressions controlling sex, work hours, experience, race, and children in the home showed the intervention's positive effects on burnout and job satisfaction remained significant (all p < .02).

LIMITATIONS

For privacy reasons, all survey responses were anonymous, meaning that individual pre-post changes could not be tracked.

CONCLUSION

We believe the intervention resulted in substantial burnout prevention and is feasible for adoption in most hospitals and clinics.

摘要

背景

在 COVID-19 大流行期间,医生倦怠感增加。

目的

评估一项旨在减少医院医生倦怠感的多模式工作场所干预措施的有效性。

设计

参与者和设置:我们的干预组由普罗维登斯波特兰医疗中心的内科医院医生组成(包括 58 名医生和 6 名护士从业者在内的 64 名参与者)。我们的对照组由普罗维登斯圣文森特医院的内科医院医生组成(包括 59 名医生和 6 名护士从业者)。

测量

在 12 个月的干预期(2020 年 10 月和 2021 年 10 月再次)进行了两次调查。调查包括人口统计学、工作满意度、马斯拉赫倦怠量表、大流行经历调查以及关于离职的两个问题。

干预措施

三名被指定为健康战士的医院医生每周组织 COVID 小组会议,提供有关 COVID-19 感染率、治疗方法和工作流程变化的最新信息。讨论包括应对和疫苗犹豫、困难病例汇报以及重症监护病房更新。还提供了个人辅导。记录会议纪要,并为异步访问录制会议。

结果

干预前,两个地点在倦怠或工作满意度方面没有明显差异。干预后,干预组报告倦怠率为 32%,而对照组报告倦怠率为 56%(p=0.024)。干预组有 48%的人报告高度的健康支持,而对照组为 0%(p<0.001)。干预组将 44%的健康支持归因于普罗维登斯一家,而对照组为 12%(p<0.001)。控制性别、工作时间、经验、种族和家中儿童的回归显示,干预对倦怠和工作满意度的积极影响仍然显著(所有 p<0.02)。

局限性

由于隐私原因,所有调查回复均为匿名,这意味着无法跟踪个人干预前后的变化。

结论

我们认为该干预措施有效地预防了倦怠感,并且在大多数医院和诊所都可以采用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b44f/10110805/cc27c87d9985/11606_2023_8041_Fig1_HTML.jpg

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