Objective To evaluate the effect of chair placement on length of time physicians sit during a bedside consultation and patients’ satisfaction. Design Single center, double blind, randomized controlled deception trial. Setting County hospital in Texas, USA. Participants 51 hospitalist physicians providing direct care services, and 125 observed encounters of patients who could answer four orientation questions correctly before study entry, April 2022 to February 2023. Intervention Each patient encounter was randomized to either chair placement (≤3 feet (0.9 m) of patient’s bedside and facing the bed) or usual chair location (control). Main outcome measures The primary outcome was the binary decision of the physician to sit or not sit at any point during a patient encounter. Secondary outcomes included patient satisfaction, as assessed with the Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH) and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, time in the room, and both physicians’ and patients’ perception of time in the room. Results 125 patient encounters were randomized (60 to chair placement and 65 to control). 38 of the 60 physicians in the chair placement group sat during the patient encounter compared with five of the 65 physicians in the control group (odds ratio 20.7, 95% confidence interval 7.2 to 59.4; P<0.001). The absolute risk difference between the intervention and control groups was 0.55 (95% confidence interval 0.42 to 0.69). Overall, 1.8 chairs needed to be placed for a physician to sit. Intervention was associated with 3.9% greater TAISCH scores (effect estimate 3.9, 95% confidence interval 0.9 to 7.0; P=0.01) and 5.1 greater odds of complete scores on HCAHPS (95% confidence interval 1.06 to 24.9, P=0.04). Chair placement was not associated with time spent in the room (10.6 minutes v control 10.6 minutes) nor perception of time in the room for physicians (9.4 minutes v 9.8 minutes) or patients (13.1 minutes v 13.5 minutes). Conclusion Chair placement is a simple, no cost, low tech intervention that increases a physician’s likelihood of sitting during a bedside consultation and resulted in higher patients’ scores for both satisfaction and communication. Trial registration ClinicalTrials.gov [NCT05250778][1]. No additional data available. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05250778&atom=%2Fbmj%2F383%2Fbmj-2023-076309.atom

中文翻译：

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椅子放置对医生行为和患者满意度的影响：随机欺骗试验


目的 评价椅子摆放位置对医生床边会诊时就坐时间和患者满意度的影响。设计单中心、双盲、随机对照欺骗试验。位于美国德克萨斯州的县医院。参与者 2022 年 4 月至 2023 年 2 月，提供直接护理服务的 51 名住院医生，以及 125 名观察到的患者，他们在研究开始前能够正确回答四个方向问题。 干预 每个患者的遭遇被随机分配到任一椅子放置位置（≤3 英尺（0.9 m））患者床边并面向床）或通常的椅子位置（对照）。主要结果指标 主要结果是医生在与患者会面时随时做出坐或不坐的二元决定。次要结果包括患者满意度（通过住院医生护理满意度评估工具 (TAISCH) 和医疗保健提供者和系统的医院消费者评估 (HCAHPS) 调查进行评估）、在病房的时间以及医生和患者的看法在房间里的时间。结果 125 名患者被随机分配（60 名接受椅子放置，65 名接受对照）。椅子放置组的 60 名医生中有 38 名在患者就诊期间坐着，而对照组的 65 名医生中有 5 名（比值比 20.7，95% 置信区间 7.2 至 59.4；P<0.001）。干预组和对照组之间的绝对风险差异为 0.55（95% 置信区间为 0.42 至 0.69）。总共需要放置1.8把椅子供医生坐。干预与 TAISCH 得分提高 3.9%（效果估计 3.9，95% 置信区间 0.9 至 7.0；P=0.01）相关，HCAHPS 完整得分的几率提高 5.1%（95% 置信区间 1.0）。06 至 24.9，P=0.04）。椅子的放置位置与在房间里花费的时间（10.6 分钟 vs 对照 10.6 分钟）以及医生（9.4 分钟 vs 9.8 分钟）或患者（13.1 分钟 vs 13.5 分钟）在房间里的时间感知无关。结论 椅子放置是一种简单、无成本、技术含量低的干预措施，它增加了医生在床边会诊期间就坐的可能性，并导致患者在满意度和沟通方面得分更高。试验注册 ClinicalTrials.gov [NCT05250778][1]。没有其他可用数据。 [1]：/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05250778&atom=%2Fbmj%2F383%2Fbmj-2023-076309。原子