Ubel P A, Zell M M, Miller D J, Fischer G S, Peters-Stefani D, Arnold R M
Department of Medicine, Veterans Affairs Medical Center, Philadelphia, Pennsylvania 19104, USA.
Am J Med. 1995 Aug;99(2):190-4. doi: 10.1016/s0002-9343(99)80139-9.
We conducted a study to determine the type and frequency of inappropriate comments made by hospital employees while riding hospital elevators.
Four observers rode in elevators at five hospitals, listening for any comments made by hospital employees that might be deemed inappropriate. All potentially inappropriate comments were reviewed by the research team and were classified as inappropriate if they met at least one of the following criteria: violated patient confidentiality, raised concerns about the speaker's ability or desire to provide high-quality patient care, raised concerns about poor quality of care in the hospital (by persons other than the speaker), or contained derogatory remarks about patients or their families.
We observed 259 one-way elevator trips offering opportunity for conversation. We overheard a total of 39 inappropriate comments, which took place on 36 rides (13.9% of the trips). The most frequent comments (18) were violations of patients confidentiality. Next most frequent (10 comments) were unprofessional remarks in which clinicians talked about themselves in ways that raised questions about their ability or desire to provide high-quality patient care. Other comments included derogatory statements about the general quality of hospital care (8) and derogatory remarks about patients (5). Physicians were involved in 15 of the comments, nurses in 10, and other hospital employees in the remainder.
Inappropriate comments took place with disturbing frequency in the elevator rides we sampled. These comments did not exclusively involve violations of patient confidentiality, but encompassed a range of discussions that health care employees must be careful to avoid.
我们开展了一项研究，以确定医院员工在乘坐医院电梯时发表的不当言论的类型和频率。
四名观察者在五家医院乘坐电梯，倾听医院员工可能被视为不当的任何言论。研究团队对所有可能不当的言论进行了审查，如果符合以下至少一项标准，则被归类为不当言论：违反患者保密规定、引发对发言者提供高质量患者护理的能力或意愿的担忧、引发对医院护理质量差的担忧（发言者以外的人）或包含对患者或其家属的贬损言论。
我们观察到259次单向电梯行程，提供了交谈机会。我们总共无意中听到39条不当言论，发生在36次行程中（占行程的13.9%）。最常见的言论（18条）是违反患者保密规定。其次最常见的（10条言论）是不专业的言论，临床医生以引发对其提供高质量患者护理的能力或意愿的质疑的方式谈论自己。其他言论包括对医院护理总体质量的贬损性陈述（8条）和对患者的贬损言论（5条）。医生参与了15条言论，护士参与了10条，其余由其他医院员工参与。
在我们抽样的电梯行程中，不当言论出现的频率令人不安。这些言论并不只涉及违反患者保密规定，而是涵盖了一系列医护人员必须小心避免的讨论。
