Aishwarya Natarajan is a medical student at the University of California, San Francisco School of Medicine. She was the executive director of The Healthcare Improvement and Innovation in Quality (THINQ) Collaborative, Department of Medicine, University of California, Los Angeles (UCLA) Health from 2020 to 2021.
Manuel G. Venegas III is a medical student at the University of Southern California, Keck School of Medicine, Los Angeles. He was a fellow of the THINQ Collaborative in the Department of Medicine at UCLA Health from 2020 to 2022.
Am J Crit Care. 2024 Sep 1;33(5):364-372. doi: 10.4037/ajcc2024308.
Communication and collaboration among health care professionals during bedside rounds improve patient outcomes and nurses' and physicians' satisfaction.
To determine barriers to nurse-physician communication during bedside rounds and identify opportunities to improve nurse-physician collaboration at an academic medical center.
A survey with Likert-scale and open-ended questions regarding professional attitudes toward nurse-physician communication was administered to 220 nurses and physicians in medical-surgical units to assess perceptions of participation in bedside rounds. After the survey was given, observational data from 1007 bedside rounds were collected via a standardized data collection tool.
Nurses and physicians perceived different barriers to including nurses in bedside rounds. Nurses most often cited being unaware that bedside rounds were occurring (38 of 46 nurses [83%]); physicians most often cited nurse unavailability (43 of 52 physicians [83%]). Of 1007 observed rounds, 602 (60%) involved in-person contact of nurses and physicians; 418 (69%) of the 602 included a conversation between the nurse and physician about the nurse's concerns. Of 355 rounds with no in-person or telephone contact between nurses and physicians, the medicine team did not contact the nurse in 284 (80%). Conversations about nurses' concerns occurred more often after physician-initiated contacts (73% of 369 contacts) and nurse-initiated contacts (74% of 93 contacts) than after chance encounters (57% of 140 contacts).
Initiating discussions of care between nurses and physicians and discussing nurses' concerns during bedside rounds have multiple benefits.
医护人员在床边查房时进行沟通与协作，可改善患者结局，并提升护士和医生的满意度。
确定在床边查房期间阻碍护士与医生沟通的因素，并确定改善学术医疗中心医护协作的机会。
我们向医疗外科病房的 220 名护士和医生发放了一份包含有关护士与医生沟通的专业态度的利克特量表和开放性问题的调查问卷，以评估他们对参与床边查房的看法。在调查完成后，我们通过标准化数据收集工具收集了 1007 次床边查房的观察数据。
护士和医生对将护士纳入床边查房存在不同的阻碍因素。护士最常提到的是不知道正在进行床边查房（46 名护士中有 38 名[83%]）；医生最常提到的是护士无法到场（52 名医生中有 43 名[83%]）。在观察到的 1007 次查房中，有 602 次（60%）涉及护士和医生的当面接触；在这 602 次查房中，有 418 次（69%）包括护士和医生就护士的关切进行了对话。在 355 次没有护士和医生当面或电话接触的查房中，医生团队在 284 次（80%）中未联系护士。在医生主动接触（369 次接触中的 73%）和护士主动接触（93 次接触中的 74%）后，更常发生关于护士关切的讨论，而在偶然相遇（140 次接触中的 57%）后则不然。
在床边查房期间发起护士与医生之间的护理讨论，并讨论护士的关切问题，有诸多益处。
