Evans Jessica, Ruller Sydney, Wooller Krista, Saraqini Delvina Hasimja, Gaudreau-Simard Mathilde
Division of General Internal Medicine, Department of Medicine, The Ottawa Hospital, Ottawa, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
BMC Med Educ. 2025 Jan 29;25(1):149. doi: 10.1186/s12909-025-06656-3.
Hospital strain has been shown to negatively impact physician wellness, educational experience, and patient care. To address rising service demands, a non-academic hospitalist service was implemented to reduce daily clinical teaching unit (CTU) census by approximately 30%. Secondary aims were to evaluate physician and trainee wellness on CTU as well as assess unintended adverse patient outcomes.
A two-phase intervention was implemented at one of two academic hospital campuses in January and April 2023. Mean daily census, mortality, 30-day readmissions, and length of stay (LOS) were obtained from an administrative database for the pre-study (October to December 2022) and study (January to December 2023) periods. The Mini-Z physician wellness survey was administered in March, June and December 2023. Data were analyzed by quarters using descriptive statistics as well as parametric and non-parametric testing, and a reflexive thematic analysis was undertaken.
A CTU census trough of 71.3 was briefly attained in the second quarter of 2023 but increased to 78.6 in the fourth quarter of 2023, while remaining below pre-intervention levels. The proportion of attendings and residents reporting burnout was significantly different at the intervention (65.2%, n = 15/23) versus non-intervention site (94.1%, n = 16/17) in Q4 2023 (p = 0.033). Burnout was positively correlated with daily CTU census across both sites (r = 0.906). There were no differences in proportion of in-hospital mortality (p = 0.854), 30-day readmissions (p = 0.262), or LOS (p = 0.977) between the pre- and post-implementation periods. Qualitative analysis identified the hospitalist program as beneficial, but inadequate to address workload, education challenges, and patient safety concerns.
The addition of a non-academic hospitalist service reduced CTU census numbers and improved burnout, but the improvement in service strain was limited by rising admissions. Multifaceted approaches to wellness are needed, but this study supports ongoing endeavors aimed at reducing clinical workload to optimize the clinical teaching environment.
医院压力已被证明会对医生的健康、教育体验和患者护理产生负面影响。为了应对不断增长的服务需求，实施了一项非学术性的医院医师服务，以使每日临床教学单元（CTU）的普查人数减少约30%。次要目标是评估CTU上医生和实习生的健康状况，并评估意外的不良患者结局。
2023年1月和4月在两个学术医院校区之一实施了两阶段干预。从行政数据库中获取研究前（2022年10月至12月）和研究期间（2023年1月至12月）的平均每日普查人数、死亡率、30天再入院率和住院时间（LOS）。2023年3月、6月和12月进行了Mini-Z医生健康状况调查。使用描述性统计以及参数和非参数检验按季度分析数据，并进行了反思性主题分析。
2023年第二季度短暂达到了71.3的CTU普查低谷，但在2023年第四季度增加到78.6，仍低于干预前水平。2023年第四季度，干预地点（65.2%，n = 15/23）与非干预地点（94.1%，n = 16/17）报告职业倦怠的主治医生和住院医生比例存在显著差异（p = 0.033）。两个地点的职业倦怠与每日CTU普查人数均呈正相关（r = 0.906）。实施前后的院内死亡率（p = 0.854）、30天再入院率（p = 0.262）或住院时间（p = 0.977）没有差异。定性分析确定医院医师项目是有益的，但不足以应对工作量、教育挑战和患者安全问题。
增加非学术性医院医师服务减少了CTU普查人数并改善了职业倦怠，但服务压力的改善受到入院人数增加的限制。需要采取多方面的健康方法，但本研究支持旨在减少临床工作量以优化临床教学环境的持续努力。
