Work Conditions of Surgery Residents and Quality of Care

描述（应用摘要）：美国的研究生外科教育 各国强调实现分级权威和增加责任 为外科住院医师提供更多的培训。 个人因素，如 压力、疲劳或睡眠不足、工作量和监督的充分性 和支持服务可能会对居民的判断产生不利影响， #21453;，威胁患者安全。 手术服务的变化 护理，如短期住院和门诊手术护理， 提高了外科住院医师所在医院的患者的敏锐度， 主要是因为工作量增加了。 同时削减成本 医院采取的措施，如取消或减少支助人员， 给外科住院医生带来了额外的工作负担。 护理的变化 工作人员配置模式损害了团队精神的发展， 影响了住院医师和护士之间的沟通。 原则 教育作为外科住院医师计划的首要任务受到威胁， 日益增长的服务需求。 这些因素中的每一个对 护理质量和患者安全未知。 研究这些问题并确定压力因素的相对重要性 在外科住院医生的表现和病人安全方面，我们建议制定 对住院医师、主治医师和手术护士进行调查， 麻醉服务。 这些调查将评估团队合作、协作， 安全文化、组织文化和压力。 其他调查项目 具体到外科住院医师将评估工作时间，债务，家庭 问题和支持服务，服务与教育的平衡，以及 态度和行为。 调查结果与 机构中不良事件的记录和分析 可预防的不良事件将提供有关 各种住院医师压力因素对患者安全的影响。

DESCRIPTION (APPLICATION ABSTRACT): Graduate surgical education in the United States emphasizes attainment of graded authority and increasing responsibility for surgery residents as experience is gained. Factors such as personal stress, fatigue or sleep deprivation, workload, and adequacy of supervision and support services may adversely affect the residents' judgment and performance and threaten patient safety. Changes in the delivery of surgical care, such as short hospital stays and outpatient surgical care, have increased the acuity of patients in the hospital where surgery residents are primarily based and have increased their workload. Simultaneous cost-cutting measures by hospitals, such as elimination or reduction of support staff, have placed additional work burdens on surgery residents. Changes in nursing staffing patterns have impaired the development of teamwork and adversely affected communication between residents and nurses. The principle of education as the top priority of a surgery residency program is threatened by an increasing need for service. The influence of each of these factors on quality of care and patient safety is unknown. To study these issues and determine the relative importance of stress factors on surgery resident performance and patient safety, we propose to develop surveys for residents, attending staff, and nurses on surgery and anesthesiology services. The surveys will assess teamwork, collaboration, safety culture, organizational culture, and stress. Additional survey items specific for surgery residents will assess working hours, indebtedness, family issues and support services, the balance of service versus education, and attitudes and behavior. Correlation and linkage of survey results with documentation of adverse events in the institution and an analysis of preventable adverse events will provide information concerning the relative effects of various resident stress factors on patient safety.