Weingart S N
Dept. of Medicine, Beth Israel Hospital, Boston, MA 02215, USA.
Jt Comm J Qual Improv. 1996 Sep;22(9):640-6. doi: 10.1016/s1070-3241(16)30271-1.
House officers are physicians-in-training who provide the bulk of direct medical care for patients in teaching hospitals. Because of their intimate, ongoing role in patient care, they occupy a particularly advantageous position in the health care system for identifying and solving common organizational problems that undermine the quality and increase the cost of care. Yet most house officers are inadequately prepared to address problems in organizational and technical support systems which undermine the delivery of health care. In fact, house officers' strategies for coping with the demands of residency training often perpetuate problems.
Cases describing prescription errors, lost laboratory data, and inappropriate beeper-related interruptions in care illustrate how house officers contribute unwittingly to poor quality and costly care.
Department chairs, residency program directors, and senior clinicians should create opportunities for house officers to participate in interdisciplinary problem-solving teams. Medical faculty should instruct house officers in the principles and practice of quality improvement, integrating this material into existing teaching conferences and other educational activities. Instruction should be case based, data intensive, and jargon free, modeled by clinicians with training and experience in quality management and related disciplines. Senior clinicians and department officials should endorse organizational problem solving as a legitimate, appropriate, and valuable activity for every well-trained physician.
住院医师是正在接受培训的医生，他们在教学医院为患者提供大部分直接医疗服务。由于他们在患者护理中持续且密切的作用，他们在医疗保健系统中处于特别有利的地位，能够识别和解决那些破坏医疗质量并增加医疗成本的常见组织问题。然而，大多数住院医师在应对组织和技术支持系统中存在的、会影响医疗服务提供的问题时准备不足。事实上，住院医师应对住院医师培训要求的策略往往使问题持续存在。
描述处方错误、实验室数据丢失以及与传呼机相关的不适当护理中断的案例，说明了住院医师如何在不知不觉中导致低质量和高成本的护理。
科室主任、住院医师培训项目主任和资深临床医生应为住院医师创造参与跨学科问题解决团队的机会。医学教员应指导住院医师掌握质量改进的原则和实践，并将这些内容融入现有的教学会议和其他教育活动中。教学应以案例为基础、数据丰富且无行话，由在质量管理及相关学科接受过培训并有经验的临床医生示范。资深临床医生和科室官员应认可组织问题解决是每一位训练有素的医生的一项合理、恰当且有价值的活动。
