Search results for "Hospitals"

The weekend effect has been observed across multiple health care settings. This study of outcomes on an all-hours trauma service found no weekend effect, suggesting that staffing structure may play a role in the weekend effect in other settings.

Nurse workload can contribute to burnout and diminish patient safety. This study found that rotating schedules were associated with higher reported fatigue among nurses. Introducing more breaks during shifts, limiting shift duration, and mandating 48-hour breaks between night-to-day rotations led to decreased nurse fatigue.

A recent cluster-randomized trial found no significant differences in patient outcomes or resident satisfaction between residency programs with flexible duty hours and those with standard duty hours. This survey examined surgical program directors' perceptions within this trial. Respondents from flexible duty hours programs reported a more positive effect of duty hours on patient safety, continuity of care, and attendance at educational activities. These results echo earlier studies that found clinical faculty had concerns about duty hour restrictions leading to a loss of educational opportunities, decreased continuity of care, and worsened resident–patient relationships.

The weekend effect is a well-documented phenomenon where patients admitted over the weekend have inferior outcomes compared to those admitted on a weekday. This retrospective study utilized the AHRQ Healthcare Cost and Utilization Project database and found that specific factors, such as full adoption of electronic health records, home health programs, and increased nurse-to-bed ratios, were associated with overcoming the weekend effect in hospitals.

Residency training presents challenges to patient safety, including increased handoffs due to duty-hour reform. While residents are completing inpatient and outpatient training simultaneously, providing outpatients with continuity of care poses an additional complication. In this pre-post survey study, investigators found that separating inpatient and outpatient responsibilities for residents enhanced their perceptions of patient safety in both settings. This intervention also improved patient continuity (the proportion of visits for which residents saw their own patients); heightened continuity is thought to foster timely and accurate diagnosis. This study offers a replicable intervention to address some patient safety risks associated with medical residency. A previous WebM&M commentary discusses safety hazards and educational challenges related to academic year-end transfers.

Certified registered nurse anesthetists (CRNAs) do not have formal restrictions on their work hours. This survey found that more than half of CRNAs worked extended duration (greater than 16 hour) shifts, and nearly one-third reported committing a medical error due to fatigue.

This large observational study demonstrated that hand hygiene compliance rates decrease over the course of a normal work shift. During the first hour of work, average compliance rates were approximately 43%. This dropped to 35% for the last hour of a 12-hour shift. In addition, more intense work shifts were associated with even bigger hand hygiene compliance drop-offs. The authors extrapolate these results to estimate that this compliance decrement could produce an additional 600,000 infections per year in the United States, resulting in up to 35,000 unnecessary deaths and $12.5 billion in excess costs. More time off between shifts led to better compliance rates during a subsequent shift. In this sample, 65% of the caregivers were nurses, and only 4% were physicians. Longer nursing shifts have previously been linked to other patient safety hazards. A prior AHRQ WebM&M commentary discussed challenges related to nursing staffing.

Although 12-hour nursing shifts are common in the United States, this study found that only 15% of European nurses worked 12 hours or more. Similar to prior research, longer nursing shifts were associated with lower quality of care and compromised patient safety. This study also found that nurses working extended shifts reported more care left undone. Nurses who worked overtime, even if shift length was less than 10 hours, described similar concerns. The authors warn that policies to adopt standard 12-hour nursing shifts as a cost-effective way of maintaining nurse–patient ratios may contribute to burnout. A past AHRQ WebM&M interview with Barbara Blakeney discussed the importance of proper nursing staffing for patient safety, and a prior AHRQ WebM&M commentary examines the complexities around balancing nurse staffing and workload.

Clinician fatigue can contribute to poor decision-making and clinical performance. This review explores the prevalence of nurse fatigue and describes work-related factors that influence fatigue among nurses. The authors suggest implementing institution-wide policies and educating nurses and administrators about risks related to fatigue to address the problem.

This article describes how wearable technologies for clinicians can improve workload distribution, information gathering, and staffing decisions to address safety issues, particularly nurse fatigue.

Many studies have demonstrated the link between health care worker fatigue and increased risk of errors. Highlighting the pervasive concern of nurses reporting fatigue, this commentary relates recommendations to help limit its effects, including managing caffeine intake, enlisting team support, and utilizing good sleep habits.

This direct observation study found that registered nurses, physicians, and nursing aides have frequent interruptions and limited time for shift-change handoffs. This finding suggests that widespread efforts to ensure adequate handoff time and minimize interruptions have not mitigated these problems in hospital settings.

This retrospective cohort study across nine European countries revealed that higher patient–nurse staffing ratios increased the likelihood of inpatient mortality. A larger proportion of nurses with bachelor's degrees decreased this risk, consistent with previous research that found a relationship between nurse education levels and patient outcomes. This finding emphasizes the importance of maintaining an adequately staffed and trained nursing workforce to support safety in hospitals.

Sleep deprivation can worsen clinical performance. Early studies on the effects of fatigue in clinical trainees formed some of the basis behind duty hour restrictions for resident physicians. This study surveyed intensive care unit (ICU) nurses about levels of fatigue and clinical decision-making. Nurses who regretted a clinical decision were more apt to be fatigued and to work 12-hour shifts. Sleep deprivation among ICU nurses was found to be common, with almost three-quarters of surveyed nurses having lost 8 or more hours of sleep in a 5-day period. The study was limited by a very low (17%) response rate, potentially biasing the results. Prior research has linked extended nursing shift lengths with compromised patient safety.

Around-the-clock staffing with faculty intensive care specialists did not improve clinical outcomes in a medical intensive care unit, compared with the traditional staffing model of daytime-only attending physicians.

Following hospitalization for suicidality, a woman was discharged to the care of her outpatient psychiatrist, a senior resident who was about to graduate. At her last visit in June before the year-end transfer, the patient was unable to schedule a follow-up visit because the new residents' schedules were not yet in the system. The delay in care had deadly consequences.

This ethnographic study describes the complexity of medication administration and competing demands affecting nurses' workdays.

This survey of hospital and nursing unit leaders found a perception that nurses could help achieve high quality care in response to financial incentives. However, nurse leaders expressed several concerns about the impact of such incentives systems on nursing workload, staffing, and satisfaction.

This commentary discusses complications with rescheduling elective procedures due to surgeon sleep deprivation and encourages the evaluation of policy solutions to inform patients and families of provider fatigue.

This study found that poorly designed shifts negatively impact physician perceptions of professional performance and educational training.