Safety in Numbers: Lack of Evidence to Indicate the Number of Physicians Needed to Provide Safe Acute Medical Care

Overview

Journal Clin Med (Lond)

Specialty General Medicine

Date 2014 Oct 11

PMID 25301904

Citations 6

Authors

Jodie Sabin

Christian P Subbe

Louella Vaughan

Rhid Dowdle

Affiliations

Soon will be listed here.

Abstract

Patient safety in hospital is dependent on a multitude of factors. Recent reports into the failings of healthcare organisations in the UK have highlighted low staffing levels as a significant factor. There is research into the impact of nurse-to-patient ratios on patient safety, but our literature search found little published data that would allow healthcare providers to define a minimum number of physician staff and skills mix that would assure safety in the largest hospital specialty: unscheduled (acute) medicine. Future work should focus on the evaluation of existing data on hospital mortality rates and physician staffing levels as well as on empirical time and motion studies to ascertain the resources required to undertake safe medical care at times of peak demand.

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References

Laxmisan A, Hakimzada F, Sayan O, Green R, Zhang J, Patel V . The multitasking clinician: decision-making and cognitive demand during and after team handoffs in emergency care. Int J Med Inform. 2006; 76(11-12):801-11. DOI: 10.1016/j.ijmedinf.2006.09.019. View

Chaponda M, Borra M, Beeching N, Almond D, Williams P, Hammond M . The value of the post-take ward round: are new working patterns compromising junior doctor education?. Clin Med (Lond). 2009; 9(4):323-6. PMC: 4952497. DOI: 10.7861/clinmedicine.9-4-323. View

Aiken L, Clarke S, Sloane D, Sochalski J, Silber J . Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002; 288(16):1987-93. DOI: 10.1001/jama.288.16.1987. View

Averbukh Y, Southern W . The impact of the number of admissions to the inpatient medical teaching team on patient safety outcomes. J Grad Med Educ. 2013; 4(3):307-11. PMC: 3444182. DOI: 10.4300/JGME-D-11-00190.1. View

Thanarajasingam U, McDonald F, Halvorsen A, Naessens J, Cabanela R, Johnson M . Service census caps and unit-based admissions: resident workload, conference attendance, duty hour compliance, and patient safety. Mayo Clin Proc. 2012; 87(4):320-7. PMC: 3538463. DOI: 10.1016/j.mayocp.2011.12.012. View

Butler M, Collins R, Drennan J, Halligan P, OMathuna D, Schultz T . Hospital nurse staffing models and patient and staff-related outcomes. Cochrane Database Syst Rev. 2011; (7):CD007019. DOI: 10.1002/14651858.CD007019.pub2. View

Ong M, Bostrom A, Vidyarthi A, McCulloch C, Auerbach A . House staff team workload and organization effects on patient outcomes in an academic general internal medicine inpatient service. Arch Intern Med. 2007; 167(1):47-52. DOI: 10.1001/archinte.167.1.47. View

Haney E, Nicolaidis C, Hunter A, Chan B, Cooney T, Bowen J . Relationship between resident workload and self-perceived learning on inpatient medicine wards: a longitudinal study. BMC Med Educ. 2006; 6:35. PMC: 1550230. DOI: 10.1186/1472-6920-6-35. View

Michtalik H, Pronovost P, Marsteller J, Spetz J, Brotman D . Developing a model for attending physician workload and outcomes. JAMA Intern Med. 2013; 173(11):1026-8. DOI: 10.1001/jamainternmed.2013.405. View

10.

Innes G, Stenstrom R, Grafstein E, Christenson J . Prospective time study derivation of emergency physician workload predictors. CJEM. 2007; 7(5):299-308. DOI: 10.1017/s1481803500014482. View

11.

Gill D, Gaunt R, Hamdulay S . No substitute for experience: do consultants that have been practising for longer lead faster post-take medical ward rounds?. Acute Med. 2013; 12(3):141-5. View

12.

Herring R, Desai T, Caldwell G . Quality and safety at the point of care: how long should a ward round take?. Clin Med (Lond). 2011; 11(1):20-2. PMC: 5873793. DOI: 10.7861/clinmedicine.11-1-20. View

13.

Moonesinghe S, Lowery J, Shahi N, Millen A, Beard J . Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review. BMJ. 2011; 342:d1580. DOI: 10.1136/bmj.d1580. View

14.

Stickrath C, Noble M, Prochazka A, Anderson M, Griffiths M, Manheim J . Attending rounds in the current era: what is and is not happening. JAMA Intern Med. 2013; 173(12):1084-9. DOI: 10.1001/jamainternmed.2013.6041. View

15.

Le Jeune I, Simmonds M, Poole L . Patient need at the heart of workforce planning: the use of supply and demand analysis in a large teaching hospital's acute medical unit. Clin Med (Lond). 2012; 12(4):312-6. PMC: 4952116. DOI: 10.7861/clinmedicine.12-4-312. View

16.

Dubinsky I . Emergency physician workload modeling. CJEM. 2012; 14(4):215-20. DOI: 10.2310/8000.2012.120532. View

17.

Dellit T, Bosl G, Sepkowitz K, Thaler H, Blaskovich J . A method for assessing house staff workload as a function of length of stay. JAMA. 2001; 286(9):1023-4. DOI: 10.1001/jama.286.9.1023. View

18.

Tourangeau A, Doran D, McGillis Hall L, Pallas L, Pringle D, Tu J . Impact of hospital nursing care on 30-day mortality for acute medical patients. J Adv Nurs. 2006; 57(1):32-44. DOI: 10.1111/j.1365-2648.2006.04084.x. View

19.

Anderson C, Zaric G, Dreyer J, Carter M, McLeod S . Physician workload and the Canadian Emergency Department Triage and Acuity Scale: the Predictors of Workload in the Emergency Room (POWER) Study. CJEM. 2009; 11(4):321-9. DOI: 10.1017/s1481803500011350. View

20.

Ghazanfar M, Honore P, Nielsen T, Andersen S, Rasmussen M . Hospital admission interviews are time-consuming with several interruptions. Dan Med J. 2013; 59(12):A4534. View