Satterwhite Shannon, Nguyen Michelle-Linh T, Honcharov Vlad, McDermott Aoife M, Sarkar Urmimala
Department of Family and Community Medicine, UC Davis Health, Sacramento, CA, USA.
Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
J Gen Intern Med. 2024 Jul;39(9):1575-1582. doi: 10.1007/s11606-024-08658-1. Epub 2024 Feb 15.
There is growing, widespread recognition that expectations of US primary care vastly exceed the time and resources allocated to it. Little research has directly examined how time scarcity contributes to harm or patient safety incidents not readily capturable by population-based quality metrics.
To examine near-miss events identified by primary care physicians in which taking additional time improved patient care or prevented harm.
Qualitative study based on semi-structured interviews.
Twenty-five primary care physicians practicing in the USA.
Participants completed a survey that included demographic questions, the Ballard Organizational Temporality Scale and the Mini-Z scale, followed by a one hour qualitative interview over video-conference (Zoom). Iterative thematic qualitative data analysis was conducted.
Primary care physicians identified several types of near-miss events in which taking extra time during visits changed their clinical management. These were evident in five types of patient care episodes: high-risk social situations, high-risk medication regimens requiring patient education, high acuity conditions requiring immediate workup or treatment, interactions of physical and mental health, and investigating more subtle clinical suspicions. These near-miss events highlight the ways in which unreasonably large patient panels and packed schedules impede adequate responses to patient care episodes that are time sensitive and intensive or require flexibility.
Primary care physicians identify and address patient safety issues and high-risk situations by spending more time than allotted for a given patient encounter. Current quality metrics do not account for this critical aspect of primary care work. Current healthcare policy and organization create time scarcity. Interventions to address time scarcity and to measure its prevalence and implications for care quality and safety are urgently needed.
人们日益广泛地认识到，美国对初级保健的期望远远超出了分配给它的时间和资源。很少有研究直接考察时间稀缺如何导致基于人群的质量指标难以捕捉的伤害或患者安全事件。
研究初级保健医生识别出的险些发生的事件，在这些事件中，花费额外的时间改善了患者护理或预防了伤害。
基于半结构化访谈的定性研究。
在美国执业的25名初级保健医生。
参与者完成一项调查，其中包括人口统计学问题、巴拉德组织时间量表和迷你Z量表，随后通过视频会议（Zoom）进行一小时的定性访谈。进行了迭代主题定性数据分析。
初级保健医生识别出几种险些发生的事件类型，在这些事件中，就诊时花费额外时间改变了他们的临床管理。这在五种患者护理情况中很明显：高风险社会情况、需要患者教育的高风险药物治疗方案、需要立即检查或治疗的高急症情况、身心健康的相互作用以及调查更细微的临床怀疑。这些险些发生的事件凸显了不合理的大量患者群体和紧凑的日程安排如何阻碍对时间敏感、密集或需要灵活性的患者护理情况做出充分反应。
初级保健医生通过花费比给定患者就诊分配时间更多的时间来识别和解决患者安全问题及高风险情况。当前的质量指标没有考虑到初级保健工作的这一关键方面。当前的医疗保健政策和组织造成了时间稀缺。迫切需要采取干预措施来解决时间稀缺问题，并衡量其发生率以及对护理质量和安全的影响。
