Off-Peak Nurse Staffing

Eschiti, Valerie S.; Hamilton, Patricia

doi:10.1097/dcc.0b013e3181fd03cd

Cited by 14 publications

(12 citation statements)

References 38 publications

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“…This represents a lost opportunity for parents to serve as key partners in ensuring the safety and quality of hospital care. This may be particularly true at night, when parents are often at their children’s bedside and hospitals typically have decreased staffing 5,6,29 and busier providers who may not know patients as well. 9,30 In addition to affecting safety, lack of shared understanding at night may affect parent experience because communication with nighttime providers is associated with overall parent experience of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

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Communication and Shared Understanding Between Parents and Resident-Physicians at Night

Khan

Rogers

Forster³

et al. 2016

Hospital Pediatrics

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BACKGROUND AND OBJECTIVE Communication breakdowns between members of the health care team compromise patient safety and experience. Communication breakdowns with parents, an important but often overlooked part of the health care team, are understudied. Parents may play a particularly important role in nighttime care given decreased staffing and inadequate transitions of care at night. We studied communication breakdowns evidenced by lack of shared understanding between parents and night-team residents about the reason for admission and care plan. METHODS We conducted a prospective cohort study of parents (n = 286) and night-team senior residents (n = 34) from May 1, 2013 to October 31, 2013. Parents and residents rated communication and described patients’ reason for admission, overall plan, and overnight plan. Two physician investigators independently reviewed (κ = 0.63) resident-parent dyads, assigned subsequently dichotomized 4-point overall agreement scores, and rated plan complexity. Using clustered logistic regression, we evaluated relationships among demographics, plan complexity, and shared understanding. We also examined resident and parent perceptions of shared understanding. RESULTS We analyzed data from 257 parent-resident dyads. Among these, 45.1% were rated as lacking shared understanding (agreement score = 1 or 2). In multivariate analysis, higher plan complexity (P < .001) and length of stay (P = .002) were associated with lack of shared understanding; lower parental education was a borderline predictor (P = .05). When surveyed, parents and residents reported that they shared an understanding with one another about care plans in 86.0% and 73.1% of cases, respectively. CONCLUSIONS Parents and night-team residents frequently lack shared understanding. Family-centered care initiatives to improve parent-provider communication and shared understanding may help empower parents as partners in safe and high-quality nighttime care.

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Section: Discussionmentioning

confidence: 99%

“…2–4 Parents play a key role in hospital care. This may be particularly true at night, a time typically characterized by decreased staffing, 5,6 increased provider workload, inadequate transitions in care, 7–9 and lack of bedside rounds.…”

mentioning

confidence: 99%

Communication and Shared Understanding Between Parents and Resident-Physicians at Night

Khan

Rogers

Forster³

et al. 2016

Hospital Pediatrics

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“…At night, provider fatigue and decreased resource availability may affect outcome. (17) A higher mortality has been associated with cardiac arrest during the night, and discharge from an intensive care unit at night. (18–20) The potential difference in care at night may influence an anesthesiologist to decide to extubate a patient under more optimal conditions during daytime hours.…”

Section: Discussionmentioning

confidence: 99%

Factors That Correlate With the Decision to Delay Extubation After Multilevel Prone Spine Surgery

Anastasian¹,

Gaudet²,

Levitt

et al. 2014

Journal of Neurosurgical Anesthesiology

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Background Multi-level spinal decompressions and fusions often require long anesthetic and operative times which may result in airway edema and prolonged post-operative intubation. Delayed extubation can lead to broncho-pulmonary infections and other complications. This study analyzed which factors correlated with the decision to delay extubation after multilevel spine surgery. Methods We reviewed the records of 289 patients having multilevel spine surgery lasting 8 hours or more in the prone position from 2006 to 2012. Variables hypothesized to affect the decision of the anesthesiologist to delay extubation at the end of the surgery were collected. These included preoperative factors (age, gender, ASA Class, history of obstructive sleep apnea, BMI, previous spine surgery, current cervical surgery, anterior in addition to posterior spine surgery, emergency surgery), and intraoperative factors (difficult intubation, number of surgical levels, case time, estimated blood loss, fluid and blood administration, attending handoff and resident handoff, and case end time). We also compared the incidence of pulmonary post-operative complications between patients extubated at the end of the case to patients who had a delayed extubation. Results 126 patients (44%) were kept intubated after multilevel spine surgery. Multiple linear regression analysis showed factors that correlated with prolonged intubation included age, ASA Class, procedure duration, extent of surgery, total crystalloid volume administered, total blood volume administered, and the case end time. Patients who had a delayed extubation had a threefold higher rate of post-operative pneumonia. Conclusions Our study finds that age, ASA class, procedure duration, extent of surgery, and total crystalloid and blood volume administered correlate with the decision to delay extubation in multilevel prone spine surgery. It also finds that the time that the case ends is an independent variable that correlates with the decision not to extubate at the end of a long multi-level spinal surgery. The incidence of post-operative pneumonia is higher in patients who had a delayed extubation after surgery.

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“…2007). After conducting a systematic review of the current staffing literature and an analysis of this qualitative data, this team has also found that off‐shift nurse staffing was inadequate on nights and weekends in critical‐care units (Eschiti & Hamilton 2011).…”

Section: Introductionmentioning

confidence: 99%

“…Only a few researchers have explored the nursing work environment on off‐shifts (Hamilton et al. 2007, Eschiti & Hamilton 2011).…”

Section: Introductionmentioning

confidence: 99%

Perceptions and observations of off-shift nursing

Cordova

Phibbs

2012

Journal of Nursing Management

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Off-Peak Nurse Staffing

Cited by 14 publications

References 38 publications

Communication and Shared Understanding Between Parents and Resident-Physicians at Night

Communication and Shared Understanding Between Parents and Resident-Physicians at Night

Factors That Correlate With the Decision to Delay Extubation After Multilevel Prone Spine Surgery

Perceptions and observations of off-shift nursing

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