The Impact of Residents, Interns, and Attendings on Inpatient Laboratory Ordering Patterns: A Report From One University's Hospitalist Service
The Impact of Residents, Interns, and Attendings on Inpatient Laboratory Ordering Patterns: A Report From One University's Hospitalist Service
复制标题
DOI：
10.1097/acm.0b013e3181fd85c3
复制
发表时间：
2011-01-01
影响因子：
7.4
通讯作者：
Bellini, Lisa M.
中科院分区：
文献类型：
--
作者：
Iwashyna, Theodore J.;Fuld, Alexander;Bellini, Lisa M.
目的通过对实习生实验室测试排序模式的考察，探讨住院医师和住院医师对实习生测试排序模式和住院医师控制感知的影响。方法在2007年的一项队列研究中，作者研究了10908个病人日的实验室检测使用率和成本的变化，研究对象是宾夕法尼亚大学综合医院服务的85名实习生、56名住院医生和27名主治医生。采用普通最小二乘回归对监督医师和监督医师的方差进行划分。对实习生和住院医生进行了调查，了解他们对实验室测试顺序的感知控制。结果：45%（95%可信区间[CI]: 39 ~ 53）的实验室检测利用差异可归因于实习生的订购，26% （95% CI: 21 ~ 34）归因于住院医生，9% （95% CI: 7 ~ 16）归因于主治医生；20% （95% CI: 6-25）不能唯一归因于护理团队的特定水平。实验室费用的变化也得到了类似的结果。实习生低估了他们对实验室测试利用的控制，住院医生高估了他们的控制，两组对他们的利用相对于同龄人的评估都不准确。结论教师对实验室秩序的影响相对较小。这可能反映了主治医生对实验室使用的一致基线影响，但也可能代表错过了减少实践变化和改善患者护理的机会。观察实习生面对不同督导时实践模式的变化是衡量临床督导的一种新方法。
PurposeTo examine the laboratory test ordering patterns of interns to determine the effects of more senior residents' and attendings' supervision on trainees' patterns and residents' perceptions of control in test ordering.MethodIn a 2007 cohort study of 2,066 patients cared for by 85 interns, 56 residents, and 27 attendings on the University of Pennsylvania general medical hospitalist service, the authors studied variation in laboratory test utilization and costs in 10,908 patient-days. Ordinary least squares regression was used to partition variance among supervised and supervising physicians. Interns and residents were surveyed about their perceived control over lab test ordering.ResultsForty-five percent (95% confidence interval [CI]: 39-53) of the variation in laboratory test utilization was attributable to interns' ordering, 26% (95% CI: 21-34) to residents, and 9% (95% CI: 7-16) to attendings; 20% (95% CI: 6-25) could not be uniquely attributed to a particular level of the care team. Similar results were obtained for variation in laboratory costs. Interns underestimated their control over laboratory test utilization, residents overestimated their control, and both groups had inaccurate assessments of their utilization relative to peers.ConclusionsAttending faculty had relatively little impact on laboratory ordering patterns. This may reflect a consistent baseline impact of attending physicians on laboratory use, but it may also represent a missed opportunity to reduce practice variation and improve patient care. Observing variation in trainee practice patterns in the face of different supervisors represents a new approach to measuring the supervision in clinical settings.