Ineffective physician-nurse collaboration has been recognised to adversely impact patient and organisational outcomes, and some studies suggest an underlying factor may be that nurses and physicians have different perceptions of interprofessional collaboration (IPC). The objectives of this study were to evaluate for a difference in the perception of IPC between physicians and nurses and to explore potential contributing factors at the individual and organisational levels to any observed difference. Data including measures of perceptions of IPC were collected from a convenience sample of resident physicians (n = 47), attending physicians (n = 18), and nurses (n = 54) providing care for internal medicine patients in a large tertiary care academic medical centre. Regression analysis revealed significantly lower perceptions of IPC scores for nurses in comparison to the scores of both the resident and attending physician groups (p = .0001 for both). Although demographic and workload factors also differed by profession, only profession and workload remained significant in regression analysis. Given the known relationships between effective physician-nurse collaboration and superior patient and organisational outcomes, better defining the individual and organisational predictors of IPC scores may support development of more effective interventions targeting improvements in IPC.
Adaptive Reserve (AR) is positively associated with implementing change in ambulatory settings. Deficits in AR may lead to change fatigue or burnout. We studied the association of self-reported AR and burnout among providers to hospitalized medicine patients in an academic medical center. An electronic survey containing a 23-item Adaptive Reserve scale, burnout inventory, and demographic questions was sent to a convenience sample of nurses, house staff team members, and hospitalists. A total of 119 self-administered, online surveys collected from June 2014 to March 2015 were analyzed. Ordinal regression analyses were used to examine the association between AR and burnout. Eighty percent of participants reported either level 1 or 2 burnout. Additionally, 10.9% of participants responded level 0% and 7.6% of participants reported level 3. Participants reporting higher burnout were about three times more likely to report lower AR levels. AR is strongly associated with self-reported burnout by physicians and nurses providing inpatient care at this academic medical center. Growing evidence supports the positive association of AR to successful change implementation in ambulatory settings. Similar studies are needed to determine whether certain levels of AR can predict successful change in hospital settings.
Learning Objectives: The goal of a rapid response system (RRS) is to provide early assessment, treatment and critical care expertise outside of the ICU. There is limited research on pediatric RRS within a comprehensive cancer center (CCC). Our rapid response system consists of 2 types of calls: rapid response (RR), response within 5 min; and consult (CS), response within 30 min. The team consists of a Nurse Practitioner (NP) and respiratory therapist, supported by a Pediatric Intensive Care Unit (PICU) physician. The objectives are to 1) describe the calls evaluated by the NP led RRS within a CCC; 2) review impact of the RRS on the rate of out-of-ICU acute respiratory or cardiac arrests 1 year after opening a PICU. Methods: This retrospective chart review analyzed RR and CS from 6/16/2014 to 6/15/2015. The number of calls, age of patient, primary diagnosis, presence of bone marrow/stem cell transplant (HSCT) patients, indications, and disposition were recorded. Results: 43 RR calls and 212 CS calls occurred during the study period. RR were highest for children 13 yr or > (n= 18, 41.9%), whereas the incidence of CS was greatest for children < or = to 3 mo (n= 87, 41%). HSCT patients accounted for 25.6% (n= 11, p=0.0005) of RR and 40.6% (n= 86, p= < 0.0001) of CS (accounting for 14% of the admissions over the same time period). Indications for RR included hypotension (n= 15, 49.5%) and respiratory distress (n= 10, 23.3%). Respiratory distress (n= 57, 26.9%) was the most common indication for CS. PICU admissions occurred for 65% (n= 28) of RR, and 51% (n=109) of CS. During the study period, there were 1.9 out-of-ICU arrests per 1000 admissions. In the 2 yr prior to the study period the rate of outof-ICU arrests were 7.0 and 4.5, respectively. Conclusions: A Pediatric Nurse Practitioner led Rapid Response System within a Comprehensive Cancer Center may be effective in decreasing out-of-ICU acute respiratory or cardiac arrests. Patients who had a history of, or were being prepared for, HSCT represented a significant proportion of the rapid response system calls during the study period. 870
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