Journal article
Quality and safety during the off hours in medicine units: A mixed methods study of front-line provider perspectives
Journal of hospital medicine, Vol.9(12), pp.756-763
12/2014
DOI: 10.1002/jhm.2261
PMID: 25270535
Abstract
Background: Hospital off-hours care is associated with poor outcomes. Mutual conceptualization among provider groups may facilitate improvement efforts. Provider-perceived threats to quality are unreported.
Objectives: The objectives of this study were to identify perceived off-hours quality and safety issues, assess the most significant, and evaluate differences between nurses, and attending and housestaff physicians, and providers with day and night experience.
Design: Prospective, sequential, exploratory mixed-methods study.
Measures: Open-ended descriptions of adverse events/near misses occurring overnight (n = 190) were analyzed using thematic analysis. From these results, a survey was developed to assess perceptions of quality/frequency of each issue (7-point scale, 7 = the highest rating) and highest-quality overnight period (7-10 pm, 10 pm-1 am, 1-4 am, 4-7 am).
Results: Primary issues related to mismanagement, delivery processes, and communication/coordination. Of 214 surveys, 160 responses (75%) were received. Least-optimal issues related to "communication" (2.93) and "timeliness/safety" (3.89) of emergency department transfers; most-optimal issues related to timely lab reporting (4.70). On the 7-point scale, comparisons among nurses, and attending and housestaff physicians revealed differences in quality of "communication between physicians" (4.29 vs 6.00 vs 5.14) and "communication between consultants-primary providers" (3.46 vs 5.75 vs 4.35, P < 0.001). Comparisons between day-night providers revealed lower ratings from day providers in 12/24 items (P < 0.05), including "communication during emergency department transfers" (4.81 vs 3.86). All groups ranked 4 to 7am lowest in quality.
Conclusions: Nurses, and attending and housestaff physicians lack a shared mental model of off-hours care. Several issues, including emergency department transfers and timeliness of consults, were identified by all providers as problematic, meriting further investigation and intervention.
Details
- Title: Subtitle
- Quality and safety during the off hours in medicine units: A mixed methods study of front-line provider perspectives
- Creators
- Jed D Gonzalo - Assistant Professor of Medicine and Public Health Sciences, Assistant Dean for Health Systems Education, Pennsylvania State University College of Medicine, Pennsylvania, HersheyEileen Moser - Associate Professor of Medicine, Associate Dean for Medical Education, Pennsylvania State University College of Medicine, Pennsylvania, HersheyErik Lehman - Biostatistician, Public Health Sciences, Pennsylvania State University College of Medicine, Pennsylvania, HersheyEthan Kuperman - Clinical Assistant Professor, University of Iowa Carver College of Medicine, Iowa, Iowa City
- Resource Type
- Journal article
- Publication Details
- Journal of hospital medicine, Vol.9(12), pp.756-763
- Publisher
- Blackwell Publishing Ltd
- DOI
- 10.1002/jhm.2261
- PMID
- 25270535
- ISSN
- 1553-5592
- eISSN
- 1553-5606
- Number of pages
- 8
- Language
- English
- Date published
- 12/2014
- Academic Unit
- General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094309402771
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