Premium
Quality and safety during the off hours in medicine units: A mixed methods study of front‐line provider perspectives
Author(s) -
Gonzalo Jed D.,
Moser Eileen,
Lehman Erik,
Kuperman Ethan
Publication year - 2014
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.2261
Subject(s) - medicine , emergency department , thematic analysis , patient safety , family medicine , scale (ratio) , quality (philosophy) , quality management , exploratory research , nursing , emergency medicine , medical emergency , qualitative research , health care , operations management , social science , philosophy , physics , management system , epistemology , quantum mechanics , sociology , anthropology , economics , economic growth
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 7 am 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. Journal of Hospital Medicine 2014;9:756–763. © 2014 Society of Hospital Medicine