The 80-hour work guidelines and resident survey perceptions of quality
The 80-hour work guidelines and resident survey perceptions of quality
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DOI：
10.1016/j.jss.2006.04.010
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发表时间：
2006-10-01
影响因子：
2.2
通讯作者：
Eavey, Roland D.
中科院分区：
文献类型：
--
作者：
Biller, C. Katarina;Antonacci, Anthony C.;Eavey, Roland D.
目标。我们假设住院医生的疲劳误差应该得到改善，这与充分休息的受训者作为直接的因果效益有关。然而，患者住院护理质量是多因素的，因此仅改变单个护理人员组的一个变量对患者护理质量的影响尚不清楚。设计和参与者。本研究于2004年初对来自三个外科专科的156名住院医师进行问卷调查，了解他们在每周工作80小时前后对病人护理质量的看法。此外，最近受到工作时间限制（新限制，NR）的居民与已经受到工作时间限制（先前限制，PR）规定的纽约州实习生进行了比较。外科住院医师培训场地。主要结果测量。调查结果;各项检验的显著性水平为0.05。参与回复率为94.5%。88%的受访者通过调查主观印象表示，由于工作时间限制，患者护理质量要么不变（63%），要么更差（26%）（P = 0.003）。PR居民比NR居民更有可能报告护理质量不变或更差（P = 0.015）。总体而言，住院医师确实感知到某些类型的错误有所改善，疲劳相关的错误减少（P < 0.001），例如，在工作时间限制之后，药物（P < 0.001），判断（P = 0.001）和灵活性（P = 0.013）。然而，更多的错误被认为与护理的连续性（P < 0.001）、沟通不周（P < 0.001）和交叉覆盖的可获得性（P = 0.001）有关。尽管预期疲劳相关的错误有所改善，但大多数参与者（特别是PR住院医师）报告的印象是，在工作时间限制下，患者护理质量保持不变或有所下降。可能的解释是护理连续性、沟通不畅和交叉覆盖方面的未解决的挑战。仅仅减少工作时间似乎并不能自动提高病人的护理质量，也不能减少某些类型错误的可能性。作为全球重新评估的一部分，专门针对培训生签到范围限制的流程干预措施对今后提高医院病人护理质量的努力非常重要。(c) 2006爱思唯尔公司版权所有。
Objective. We hypothesized that resident fatigue error should improve, related to well-rested trainees as a direct cause/effect benefit. However, patient hospital care quality is multifactorial, so impact on patient care quality by changing only one variable for a single caregiver group was unknown.Design and participants. Convenience samples of 156 residents from three surgical specialties were administered a questionnaire in early 2004 addressing perceptions of patient care quality before and after the 80-h workweek. Additionally, residents recently under work-hour restrictions (Newly Restricted, NR) were compared to New York state trainees already regulated by work-hour restrictions (Previously Restricted, PR).Setting. Surgical residency training venues.Main outcome measure. Survey results; the level of significance for all tests was 0.05.Results. The participation response rate was 94.5%. Eighty-eight percent of respondents indicated by survey subjective impression, that patient care quality was either unchanged (63%) or worse (26%) due to work-hour restrictions (P = 0.003). PR residents were more likely than NR residents to report unchanged or worse quality of care (P = 0.015). Residents overall did perceive improvement in some types of error with fewer fatigue-related errors (P < 0.001), e.g., medication (P < 0.001), judgment (P = 0.001), and dexterity (P = 0.013), subsequent to work-hour restrictions. However, more errors were perceived related to con-tinuity of care (P < 0.001), miscommunication (P 0.001), and cross-coverage availability (P = 0.001).Conclusions. Despite an expected perception of improvement in fatigue-related errors, most participants (particularly PR residents) reported impressions that patient care quality had remained unchanged or had declined under the work-hour restrictions. Unresolved challenges with continuity of care, miscommunication, and cross-coverage availability are possible explanations. Mere work-hour reduction does not appear to improve patient care quality automatically nor to decrease the possibility for some types of error. Process interventions that specifically target trainee sign-out coverage constraints as part of a global reassessment will be important for future attempts to enhance quality hospital patient care. (c) 2006 Elsevier Inc. All rights reserved.