一项针对学术性医院内科危急值系统的多机构多方法分析。
A multi-institutional multi-methods analysis of jeopardy systems in academic hospital medicine.
作者信息
Kangelaris Kirsten N, Keniston Angela, Auerbach Andrew D, Bowling Gregory, Burden Marisha, Kulkarni Shradha A, Leykum Luci K, Linker Anne S, Sakumoto Matthew, Schnipper Jeffrey, Astik Gopi
机构信息
Division of Hospital Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA.
Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
出版信息
J Hosp Med. 2025 Sep;20(9):953-962. doi: 10.1002/jhm.70045. Epub 2025 Apr 14.
BACKGROUND
Hospital medicine programs use backup ("jeopardy") systems to cover unexpected staffing gaps, but little is known about their structures or optimal practices.
OBJECTIVES
To describe jeopardy structures, assess clinician perceptions, and identify potential approaches across a broad sample of hospital medicine groups.
METHODS
This multi-methods study, conducted within a national hospitalist consortium, used virtual focus groups and an email survey to (1) describe the presence and structure of jeopardy systems and (2) explore features perceived as fair, equitable, and tolerable. Rapid qualitative analysis identified major themes, while descriptive methods analyzed survey data.
RESULTS
Twenty-five individuals participated in focus groups, and 26 completed the survey, representing 31 unique institutions. Participants were primarily physicians in academic hospital medicine groups. Three themes emerged: (1) jeopardy systems are widely used but vary in structure, activation criteria, and compensation, leading to inconsistencies in clinician experiences; (2) many clinicians report stress and dissatisfaction due to unpredictability, perceived inequities in assignment, and concerns about inappropriate use; and (3) strategies to improve fairness, equity and tolerability include structured scheduling, support for sick days, and compensation for the burden of jeopardy coverage. Survey data confirmed high variability in jeopardy systems across institutions. Common practices included jeopardy activation over redistributing patients and compensating clinicians for covered shifts.
CONCLUSIONS
Jeopardy systems are essential for hospital medicine staffing but contribute to clinician dissatisfaction due to unpredictability and perceived inequities in coverage. Implementing deliberate scheduling, formalized support for absences, and equitable compensation models may reduce dissatisfaction and improve jeopardy system sustainability.
背景
医院内科项目使用后备（“应急”）系统来应对意外的人员配备缺口，但对其结构或最佳实践知之甚少。
目的
描述应急系统的结构，评估临床医生的看法，并在广泛的医院内科团队样本中确定潜在的方法。
方法
这项在全国医院医师联盟内进行的多方法研究，使用虚拟焦点小组和电子邮件调查来（1）描述应急系统的存在和结构，以及（2）探索被认为公平、公正和可容忍的特征。快速定性分析确定了主要主题，而描述性方法分析了调查数据。
结果
25人参加了焦点小组，26人完成了调查，代表31个不同的机构。参与者主要是学术医院内科团队的医生。出现了三个主题：（1）应急系统被广泛使用，但在结构、启动标准和补偿方面存在差异，导致临床医生的体验不一致；（2）许多临床医生报告因不可预测性、任务分配中的感知不公平以及对不当使用的担忧而感到压力和不满；（3）提高公平性、公正性和可容忍性的策略包括结构化排班、对病假的支持以及对应急值班负担的补偿。调查数据证实了各机构应急系统的高度变异性。常见做法包括通过重新分配患者来启动应急系统以及对值班的临床医生进行补偿。
结论
应急系统对于医院内科人员配备至关重要，但由于不可预测性和覆盖范围方面的感知不公平，会导致临床医生不满。实施精心安排的排班、对缺勤的正式支持以及公平的补偿模式可能会减少不满并提高应急系统的可持续性。
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