Docs, nurses not as good as they think they are - Health, Medical ...

Critical Care Medicine

POST AUTHOR CORRECTIONS, 10 August 2012
doi: 10.1097/CCM.0b013e31825fe2cb

How nurses and physicians judge their own quality of care for deteriorating patients on medical wards: Self-assessment of quality of care is suboptimal

Ludikhuize, Jeroen MD; Dongelmans, Dave A. MD, PhD; Smorenburg, Susanne M. MD, PhD; Gans-Langelaar, Miranda; de Jonge, Evert MD, PhD; de Rooij, Sophia E. MD, PhD
Published Ahead-of-Print

Abstract

Objective:

To describe how nurses and physicians judge their own quality of care for deteriorating patients on medical wards compared with the judgment of independent experts.

Design:

Cross-sectional study using interviews of care-providers regarding their perceived quality of care for clinically deteriorating patients compared with retrospective judgment by independent experts.

Setting:

Academic Medical Center of Amsterdam, the Netherlands.

Patients:

Between April and July 2009, all patients with cardiopulmonary arrests and unplanned intensive care unit admissions from six medical nursing wards were included. The care-providers (nurses and physicians) taking care of these patients in the previous 12 hrs were included.

Measurements and Main Results:

Forty-seven events and 198 interviews were analyzed. Skill and knowledge level regarding the recognition of a deteriorating patient were rated on a scale of 1-10 with means (SD) of 7.9 (0.8) and 7.7 (0.9), respectively. Nurses and residents attributed coordination of care largely to themselves (74% and 76%, respectively). Communication, cooperation, and coordination were graded in a positive manner (medians between 7.3 and 8), whereas the medical staff graded these factors higher compared to the grading by nurses and residents. Negative predictive values regarding the presence of a delay compared with an expert panel was 37% for nurses and 38% for residents and specialists.

Conclusions:

Care-providers mostly rate their care provided to patients in the hours preceding a life-threatening adverse event as good. In contrast, independent experts had a more critical appraisal of the provided care in regards to timely recognition. These findings may partly explain the reluctance of care-providers to implement patient safety initiatives.

Source

Source: http://www.stonehearthnewsletters.com/docs-nurses-not-as-good-as-they-think-they-are-study-in-the-journal-critical-care-medicine/medical-errors/

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