Yu Andrew T, Jepsen Nicole, Prasad Sashank, Klein Joshua P, Doughty Christopher
Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Neurohospitalist. 2023 Apr;13(2):130-136. doi: 10.1177/19418744221143207. Epub 2023 Mar 21.
: In the inpatient academic medical center, increased demand for clinical services often equates to an increased workload for trainees, which could have a positive or negative impact on their educational experience. In 2020, our academic medical center hired Advanced Practice Providers (APPs) to provide continuous additional overnight coverage for our neurology ward teaching service. We hypothesized that adding APPs and reducing overnight clinical workload for residents would have a positive impact on resident education. : We performed a mixed-methods, prospective study that included needs-assessments by residents, semi-structured interviews with both residents and APPs, and surveys to residents and nursing staff. In addition, we collected quantitative data such as hours of sleep, number of admissions, and number of pages to capture the impact of APPs on resident overnight shifts. : The addition of APPs overnight increased the median hours of sleep overnight from 1 hour to 3 hours ( < .001) and decreased the median number of pages overnight from 31.5 to 17 ( < .001). The median number of patients the resident was responsible for cross-covering overnight decreased from 24 patients to 14 patients ( < .001). The majority of resident responses (94%) agreed that the addition of APPs benefited their education by reducing workload and increasing time allotted to reading and formulating plans for overnight admissions. 88% of residents agreed that the addition of APPs improved quality of life and reduced risk of burnout. : Advanced Practice Providers significantly reduced resident workload, leading residents to report improvements in the educational experience overnight and reduced perceived risk of burnout.
在住院学术医疗中心,临床服务需求的增加通常等同于实习生工作量的增加,这可能对他们的教育经历产生积极或消极影响。2020年,我们的学术医疗中心聘请了高级实践提供者(APP)为我们的神经科病房教学服务提供持续的额外夜间覆盖。我们假设增加APP并减少住院医生的夜间临床工作量将对住院医生的教育产生积极影响。
我们进行了一项混合方法的前瞻性研究,包括住院医生的需求评估、对住院医生和APP的半结构化访谈以及对住院医生和护理人员的调查。此外,我们收集了定量数据,如睡眠时间、入院人数和页数,以了解APP对住院医生夜间值班的影响。
增加APP夜间值班后,夜间睡眠中位数时间从1小时增加到3小时(P<.001),夜间传呼中位数从31.5次减少到17次(P<.001)。住院医生负责夜间交叉覆盖的患者中位数从24例减少到14例(P<.001)。大多数住院医生的反馈(94%)同意增加APP通过减少工作量和增加阅读及制定夜间入院计划的时间而有益于他们的教育。88%的住院医生同意增加APP改善了生活质量并降低了职业倦怠风险。
高级实践提供者显著减少了住院医生的工作量,使住院医生报告夜间教育经历有所改善,且降低了感知的职业倦怠风险。