Weingart S N
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Jt Comm J Qual Improv. 1998 Jul;24(7):371-8. doi: 10.1016/s1070-3241(16)30388-1.
House officers play an important role in the care of hospitalized patients, yet they are infrequent participants in quality improvement (QI) activities. A grassroots QI initiative among medical house officers was implemented at Beth Israel Deaconess Medical Center's East Campus in Boston from 1995 through 1997.
A group of house officer volunteers completed five of nine projects, including a survey that demonstrated frequent failures of cardiac monitor-defibrillators in the emergency room. Reaching out to key administrators produced several quick fixes. Developing effective, ongoing partnerships with clinical departments and QI professionals proved more problematic.
Residency training programs that provide experience in QI give house officers a potentially valuable skill and an additional means to improve the quality of patient care. Yet many obstacles work against house officers' participation in QI initiatives, including long hours and the daily demands of patient care, rotating monthly assignments, and clinical leaders' assumption that they have little interest in QI. The organizers of the officer problem-solving group over-estimated the hospital resources at their disposal and failed to build mechanisms to ensure the initiative's continuation into its second year, when their own interest waned and no new group of leaders emerged to take their place.
House officers represent an underused resource for QI. They are skilled at identifying problems but have difficulty executing sustained and complex QI initiatives. Peer leadership is a potent means to mobilize resident-physician participation but may require faculty or staff involvement and support to guarantee its continuity.
住院医师在住院患者的护理中发挥着重要作用，但他们很少参与质量改进（QI）活动。1995年至1997年期间，在波士顿贝斯以色列女执事医疗中心东校区实施了一项由住院医师发起的基层QI倡议。
一群住院医师志愿者完成了九个项目中的五个，其中包括一项调查，该调查显示急诊室的心电监护除颤器经常出现故障。与关键管理人员沟通后迅速采取了一些解决措施。事实证明，与临床科室和QI专业人员建立有效、持续的合作关系更具挑战性。
提供QI经验的住院医师培训项目为住院医师提供了一项潜在的宝贵技能以及提高患者护理质量的额外途径。然而，许多障碍阻碍了住院医师参与QI倡议，包括工作时间长和患者护理的日常需求、每月轮换的任务安排，以及临床领导者认为他们对QI兴趣不大的假设。住院医师问题解决小组的组织者高估了他们可支配的医院资源，并且未能建立机制来确保该倡议在第二年继续进行，当时他们自己的兴趣减弱，也没有新的领导团队出现来取代他们。
住院医师是QI中未得到充分利用的资源。他们擅长识别问题，但在执行持续且复杂的QI倡议方面存在困难。同伴领导是动员住院医师参与的有效手段，但可能需要教员或工作人员的参与和支持以确保其连续性。
