Nighttime clinical encounters: How residents perceive and respond to calls at night

Abstract

BACKGROUND: Care fragmentation is common and contributes to communication errors and adverse events. Handoff tools were developed to reduce the potential for these errors. Despite their widespread adoption, there is little information describing their impact on clinical work. Understanding their impact could be helpful in improving handoffs and transitions.

Rates of ICU Transfers After a Scheduled Night-Shift Interprofessional Huddle

“…In a study by Hanson et al, the electronic medical record and bedside nurse were critical in providing additional information to help residents make decisions about patient care at night where the handoff reference may have been inadequate. 18 Improving education for residents providing overnight care to a high-risk population was an important consideration for implementing the huddle. In our preintervention culture, residents would call for assistance only with acute medical concerns.…”

Night Physician–Nurse Collaboration: Developing the Scale of Physicians’ Difficulties and Exploring Related Factors in Acute Care Hospitals

“…To explore factors relevant to the difficulties of nighttime collaboration, independent variables of the multiple regression analysis were considered based on previous studies and discussions among the researchers. [15][16][17][18][19][35][36][37][38][39][40] We finally selected and collected information on the following respondent characteristics: gender, years of experience as a physician, years of work in the current workplace, hospital type, employment, clinical specialty, number of night shifts per month, provision of night cover care for patients under another physician's charge, frequency of nighttime calls about patients under another physician's charge, handover before changing shifts, concurrent work in outpatient services, and the availability of RRS at night.…”

“…Previous evidence showed that approximately 80% or more of the calls received by physicians during the night were from nurses, 15 , 16 and more than half of the calls were deemed urgent in terms of the nature of the call. 17 , 18 These characteristics emphasize the importance of the interaction between physicians and nurses in response to clinical deterioration at night.…”

Capsule Commentary on Gonzalo, et al., Impact of an Overnight Internal Medicine Academic Hospitalist Program on Patient Outcomes

“…4 As noted by Hanson et al, nighttime education should be transformed in a way that maintains clinical productivity for both attending and resident physicians, integrates high-quality teaching and curricula, and achieves a balance between patient safety and resident autonomy. 5 The results of the study are promising and helpful for programs as they aim to implement systems to ensure appropriate nighttime supervision. Further study is needed to assess the impact on broader patient outcomes.…”