住院寄宿对急诊医学住院医师工作效率的影响。

IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE
Peter Moffett, Al Best, Nathan Lewis, Stephen Miller, Grace Hickam, Hannah Kissel-Smith, Laura Barrera, Scott Huang, Joel Moll
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引用次数: 0

摘要

简介:急诊科登机已经升级为危机,影响病人护理,医院财政,医生倦怠,并导致错误。之前没有研究调查过寄宿时间对居民生产力的影响。如果寄宿制降低了生产力,它可能会对教育产生负面影响。我们调查了寄宿对住院医生生产力的影响,以每小时的病人数量来衡量,并假设寄宿增加会导致生产力下降。方法:这是一项回顾性研究,于2017-2021年在一家四级、城市、学术一级创伤中心进行,该中心每年有10-12名急诊医学住院医师,年业务量为8万-10万。入住时间被定义为住院命令和患者离开急诊室之间的时间。我们创建了一个多变量混合模型,该模型具有固定的协变量,包括年、月、星期、住院医师经验、轮班时间、每日急诊患者总数,并将住院医师作为重复测量。在协变所有其他因素后估计登机的影响。结果:模型中包含的所有变量都与生产率的变化显著相关。住院医师经验的影响最大,每个月的住院医师经验每小时增加0.012个病人(95%置信区间[CI] 0.010-0.014)。隔离登机的影响表明,每增加100小时的登机时间,住院医生的工作效率每小时降低0.022名患者(95% CI 0.016-0.028)。在这项研究中,每天登机的中位数为261小时;如果排除这一因素(假设一名住院医生每年完成100次10小时轮班),一名住院医生每年可以多看56.9名病人(95% CI 40.7-73.1)。结论:医院寄宿显著降低了住院医师的工作效率,以每小时的病人数量来衡量。需要进一步研究以确定其对教育的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Effect of Hospital Boarding on Emergency Medicine Residency Productivity.

Introduction: Emergency department boarding has escalated to a crisis, impacting patient care, hospital finances, and physician burnout, and contributing to error. No prior studies have examined the effects of boarding hours on resident productivity. If boarding reduces productivity, it may have negative educational impacts. We investigated the effect of boarding on resident productivity as measured by patients per hour and hypothesized that increased boarding leads to decreased productivity.

Methods: This was a retrospective study at a quaternary, urban, academic Level I trauma center from 2017-2021 with a three-year emergency medicine residency of 10-12 residents per year and annual volumes of 80,000-101,000. Boarding was defined as the time between an admission order and the patient leaving the ED. We created a multivariable mixed model with fixed covariates for year, month, day of week, resident experience, shift duration, total daily ED patients, and with residents as repeated measures. The effect of boarding was estimated after covarying out all other factors.

Results: All variables included in the model were significantly associated with changes in productivity. Resident experience has the largest effect such that for each month of residency experience, a resident adds 0.012 patients per hour (95% confidence interval [CI] 0.010-0.014). Isolating the effect of boarding demonstrated that for every additional 100 hours of boarding, a resident's productivity decreased by 0.022 patients per hour (95% CI 0.016-0.028). In the study, the median daily boarding was 261 hours; if this were eliminated (assuming a resident completes 100 10-hour shifts annually), a resident could be expected to see 56.9 more patients per year (95% CI 40.7-73.1).

Conclusion: Hospital boarding significantly reduces resident productivity as measured by patients per hour. Further studies are warranted to determine the educational impact.

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来源期刊
Western Journal of Emergency Medicine
Western Journal of Emergency Medicine Medicine-Emergency Medicine
CiteScore
5.30
自引率
3.20%
发文量
125
审稿时长
16 weeks
期刊介绍: WestJEM focuses on how the systems and delivery of emergency care affects health, health disparities, and health outcomes in communities and populations worldwide, including the impact of social conditions on the composition of patients seeking care in emergency departments.
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