Work Conditions of Surgery Residents and Quality of Care

简介(申请摘要)：美国的外科研究生教育 国家强调实现分级权威和增加责任 对于外科住院医生来说，因为获得了经验。个人因素等 压力、疲劳或睡眠不足、工作量和监管的充分性 和支持服务可能会对居民的判断力和 并威胁到患者的安全。外科手术分娩方式的变化 护理，如短期住院和门诊外科护理，有 提高了外科实习医生所在医院的患者的敏锐度 主要是基于，并增加了他们的工作量。同时削减成本 医院采取的措施，如裁撤或减少辅助人员，已经 给外科住院医生带来了额外的工作负担。护理的变化 人员配置模式损害了团队合作的发展，并对 影响住院医师与护士之间的沟通。三、原则 教育作为外科住院医师计划的首要任务受到了威胁 对服务的需求日益增长。这些因素中的每一个都对 护理质量和患者安全尚不清楚。 研究这些问题并确定压力因素的相对重要性 在外科住院医师的表现和患者安全方面，我们建议发展 对住院医生、主治医生和护士进行的手术和护理调查 麻醉科服务。这些调查将评估团队合作、合作、 安全文化、组织文化和压力。其他调查项目 具体到手术住院医生将评估工作时间、负债、家庭 问题和支持服务，服务与教育的平衡，以及 态度和行为。与调查结果的关联和联动 记录机构中的不良事件并分析 可预防的不良事件将提供有关亲属的信息 各种居民应激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.