Relationships of the Location and Content of Rounds to Specialty, Institution, Patient-Census, and Team Size 英文参考文献.docVIP

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Relationships of the Location and Content of Rounds to Specialty, Institution, Patient-Census, and Team Size 英文参考文献.doc

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Relationships of the Location and Content of Rounds to Specialty, Institution, Patient-Census, and Team Size 英文参考文献

RelationshipsoftheLocationandContentofRoundsto Specialty,Institution,Patient-Census,andTeamSize JamesR.Priest1,2*,SylviaBereknyei3,KambriaHooper3,ClarenceH.Braddock III3 1SeattleChildren’sHospital,Seattle,Washington,UnitedStatesofAmerica,2DepartmentofPediatrics,UniversityofWashingtonSchoolofMedicine,Seattle,Washington, UnitedStatesofAmerica,3DepartmentofGeneralInternalMedicine,StanfordUniversitySchoolofMedicine,Stanford,California,UnitedStatesofAmerica Abstract Objective: Existing observational data describing rounds in teaching hospitals are 15 years old, predate duty-hour regulations, are limited to one institution, and do not include pediatrics. We sought to evaluate the effect of medical specialty,institution,patient-census,andteamparticipantsupontimeatthebedsideandeducationoccurringonrounds. Methods and Participants: Between December of 2007 and October of 2008 we performed 51 observations at Lucile Packard Children’s Hospital, Seattle Children’s Hospital, Stanford University Hospital, and the University of Washington Medical Center of 35 attending physicians. We recorded minutes spent on rounds in three location and seven activity categories,membersofthecareteam,andpatient-census. Results: Resultspresentedaremeans.Pediatricroundshadmoreparticipants (8.2vs.4.1physicians, p,.001;11.9vs.2.4 non-physicians,p,.001)whospentmoreminutesinhallways(96.9minvs.35.2min,p,.001),fewerminutesatthebedside (14.6 vs. 38.2min, p=.01) than internal medicine rounds. Multivariate regression modeling revealed that minutes at the bedsideperpatientwasnegativelyassociatedwithpediatrics(22.77adjustedbedsideminutes;95%CI24.61to20.93; p,.001)butpositivelyassociatedwiththenumberofnon-physicianparticipants(0.12adjustedbedsideminutespernon physician participant; 95% CI 0.07 to 0.17; p=,.001). Education minutes on rounds was positively associated with the presenceofanattendingphysician(2.70adjustededucationminutes;95%CI1.27to4.12;p,.001)andwithoneinstitution (1.39adjustededucationm