Holliman C J, Wuerz R C, Kimak M J, Burkhart K K, Donovan J W, Rudnick H L, Bates M A, Muller H A
Center for Emergency Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, USA.
Am J Emerg Med. 1995 May;13(3):259-61. doi: 10.1016/0735-6757(95)90195-7.
There have been a limited number of studies assessing the impact of attending physician supervision of residents in the emergency department (ED). The objective of this study is to describe the changes in patient care when attending emergency physicians (AEPs) supervise nonemergency medicine residents in a university hospital ED. This was a prospective study including 1,000 patients, 32 second- and third-year nonemergency medicine residents and eight AEPs. The AEPs classified changes in care for each case as major, minor, or none, according to a 40-item data sheet list. There were 153 major changes and 353 minor changes by the AEP. The most common major changes were ordering laboratory or x-ray tests that showed a clinically significant abnormality, and eliciting important physical exam findings. Potentially limb- or life-threatening errors were averted by the AEP in 17 patients. Supervision of nonemergency medicine residents in the ED resulted in frequent and clinically important changes in patient care.
评估急诊科住院医师上级医师监督影响的研究数量有限。本研究的目的是描述大学医院急诊科的急诊主治医师（AEP）监督非急诊医学住院医师时患者护理的变化。这是一项前瞻性研究，纳入了1000名患者、32名二、三年级非急诊医学住院医师和8名AEP。根据一份包含40项内容的数据表清单，AEP将每个病例的护理变化分为重大、轻微或无变化。AEP发现了153项重大变化和353项轻微变化。最常见的重大变化是开具显示临床显著异常的实验室或X光检查，以及引出重要的体格检查结果。AEP避免了17名患者出现可能危及肢体或生命的错误。在急诊科对非急诊医学住院医师的监督导致患者护理频繁出现具有临床重要意义的变化。
