Departments of Pediatrics and Health Policy, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Pediatrics, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA Netw Open. 2024 Jun 3;7(6):e2415331. doi: 10.1001/jamanetworkopen.2024.15331.
Because unprofessional behaviors are associated with patient complications, malpractice claims, and well-being concerns, monitoring concerns requiring investigation and individuals identified in multiple reports may provide important opportunities for health care leaders to support all team members.
To examine the distribution of physicians by specialty who demonstrate unprofessional behaviors measured through safety reports submitted by coworkers.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted among physicians who practiced at the 193 hospitals in the Coworker Concern Observation Reporting System (CORS), administered by the Vanderbilt Center for Patient and Professional Advocacy. Data were collected from January 2018 to December 2022.
Submitted reports concerning communication, professional responsibility, medical care, and professional integrity.
Physicians' total number and categories of CORS reports. The proportion of physicians in each specialty (nonsurgeon nonproceduralists, emergency medicine physicians, nonsurgeon proceduralists, and surgeons) who received at least 1 report and who qualified for intervention were calculated; logistic regression was used to calculate the odds of any CORS report.
The cohort included 35 120 physicians: 18 288 (52.1%) nonsurgeon nonproceduralists, 1876 (5.3%) emergency medicine physicians, 6743 (19.2%) nonsurgeon proceduralists, and 8213 (23.4%) surgeons. There were 3179 physicians (9.1%) with at least 1 CORS report. Nonsurgeon nonproceduralists had the lowest percentage of physicians with at least 1 report (1032 [5.6%]), followed by emergency medicine (204 [10.9%]), nonsurgeon proceduralists (809 [12.0%]), and surgeons (1134 [13.8%]). Nonsurgeon nonproceduralists were less likely to be named in a CORS report than other specialties (5.6% vs 12.8% for other specialties combined; difference in percentages, -7.1 percentage points; 95% CI, -7.7 to -6.5 percentage points; P < .001). Pediatric-focused nonsurgeon nonproceduralists (2897 physicians) were significantly less likely to be associated with a CORS report than nonpediatric nonsurgeon nonproceduralists (15 391 physicians) (105 [3.6%] vs 927 [6.0%]; difference in percentages, -2.4 percentage points, 95% CI, -3.2 to -1.6 percentage points; P < .001). Pediatric-focused emergency medicine physicians, nonsurgeon proceduralists, and surgeons had no significant differences in reporting compared with nonpediatric-focused physicians.
In this cohort study, less than 10% of physicians ever received a coworker report with a concern about unprofessional behavior. Monitoring reports of unprofessional behaviors provides important opportunities for health care organizations to identify and intervene as needed to support team members.
由于不专业的行为与患者并发症、医疗事故索赔和福祉问题有关，因此需要调查的监测问题和在多个报告中被点名的个人可能为医疗保健领导者提供重要机会，以支持所有团队成员。
通过同事提交的安全报告来检查表现出不专业行为的医生按专业分布的情况。
设计、地点和参与者：这项回顾性队列研究是在范德比尔特患者和专业倡导中心管理的同事关注观察报告系统（CORS）中的 193 家医院的医生中进行的。数据收集时间为 2018 年 1 月至 2022 年 12 月。
提交的关于沟通、专业责任、医疗保健和专业诚信的报告。
医生收到的 CORS 报告总数和类别。计算了每个专业（非外科非程序性医生、急诊医生、非外科程序性医生和外科医生）中至少收到 1 份报告并符合干预条件的医生比例；使用逻辑回归计算任何 CORS 报告的可能性。
该队列包括 35120 名医生：18288 名（52.1%）非外科非程序性医生、1876 名（5.3%）急诊医生、6743 名（19.2%）非外科程序性医生和 8213 名（23.4%）外科医生。有 3179 名（9.1%）医生至少有 1 份 CORS 报告。非外科非程序性医生中至少有 1 份报告的医生比例最低（56%），其次是急诊医生（10.9%）、非外科程序性医生（12.0%）和外科医生（13.8%）。非外科非程序性医生被点名参与 CORS 报告的可能性低于其他专业（5.6%比其他专业的 12.8%；百分比差异，-7.1 个百分点；95%CI，-7.7 至-6.5 个百分点；P<0.001）。专注于儿科的非外科非程序性医生（2897 名）与非儿科非外科非程序性医生（15391 名）相比，与 CORS 报告的关联性明显较低（105[3.6%]与 927[6.0%]；百分比差异，-2.4 个百分点，95%CI，-3.2 至-1.6 个百分点；P<0.001）。专注于儿科的急诊医生、非外科程序性医生和外科医生与非儿科医生相比，报告情况没有显著差异。
在这项队列研究中，不到 10%的医生曾经收到过关于不专业行为的同事报告。监测不专业行为的报告为医疗保健组织提供了重要机会，可以根据需要进行识别和干预，以支持团队成员。
