Safety in numbers: lack of evidence to indicate the number of physicians needed to provide safe acute medical care

Sabin, Jodie; Vaughan, Louella; Dowdle, Rhid

doi:10.7861/clinmedicine.14-5-462

Cited by 11 publications

(8 citation statements)

References 33 publications

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“…The key intervention for patients admitted under physician specialties is usually the care provided on the hospital ward rather than a specific intervention such as an operation [ 9 ]. A previous systematic review suggested a key aspect of hospital staffing is “service design and skill mix” [ 10 ], highlighting the importance of adequate numbers of senior and junior medical staff. It is therefore important to examine the impact of variation in the number of different grades of medical staff within physician medical specialties to optimise patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

The association between physician staff numbers and mortality in English hospitals

Harvey

Trudgill

2021

EClinicalMedicine

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Background Physician medical specialties place specific demands on medical staff. Often patients have multiple co-morbidities, frailty is common, and mortality rates are higher than other specialties such as surgery. The key intervention for patients admitted under physician subspecialties is the care provided on the ward. The current evidence base to inform staffing in physician medical specialty wards is limited. The aim of this analysis is to investigate the association between medical staffing levels within physician medical specialties and mortality. Methods This study is a cross-sectional analysis of national data, which is aggregated at provider level. Medical beds per senior, middle grade and junior physicians employed in physician medical specialties were calculated from national employment records for acute hospitals in England, in 2017. Outcome measures included unadjusted mortality rate and Summary Hospital-level Mortality Indicator (SHMI) in physician medical specialties. Both Raw mortality and SHMI include deaths during admission or within 30 days following discharge. Linear regression models were constructed for each medical staffing grade for unadjusted mortality, SHMI and SHMI adjusted for local provider factors. Findings The mean number of medical beds per senior, middle grade and junior physicians were 7.3(SD 2.5), 19.7(11.5), 10.1(3.1) respectively. Lower bed numbers per medical staff grade were associated with lower than expected mortality by SHMI; senior(Coefficient 0.012(95%CI:0.005–0.018), p = 0.001), middle grade(0.002(0.0002–0.005), p = 0.032) and junior(0.008(0.002–0.015), p = 0.014). Hospital providers were more likely to achieve a better than expected mortality (SHMI<1) if beds per physician were lower than; 5.3, 14.6 and 9.0 for senior, middle grade and junior doctors respectively. Interpretation Acute hospital providers with fewer beds per medical staff of all grades are associated with lower than expected mortality. Funding No external funding is associated with this analysis.

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Section: Introductionmentioning

confidence: 99%

The association between physician staff numbers and mortality in English hospitals

Harvey

Trudgill

2021

EClinicalMedicine

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“…2 The National Institute for Health and Care Excellence has commissioned the development of guidelines for safe levels of staffing. 3 While there is some evidence for recommendations for safe levels of staffing for nurses, 4 there is currently limited evidence available to suggest the number of doctors required to safely ABSTRACT 'The time it takes…' How doctors spend their time admitting a patient during the acute medical take manage acute hospital care. The Royal College of Physicians (RCP) recommends a minimum standard for consultant presence on acute medical units (AMUs).…”

Section: Introductionmentioning

confidence: 99%

‘The time it takes…’ How doctors spend their time admitting a patient during the acute medical take

et al. 2016

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Patient safety depends on adequate staffi ng but the number of doctors required for safe staffi ng for medical emergencies is not known. We measured the duration of the admission process for patients seen by medical teams in emergency departments (EDs) and acute medical units. History taking and examination by a core medical trainee took 22 minutes for a patient referred from the ED and 21 minutes for a patient referred from primary care. A complete admission clerking with prescription and ordering of investigations ranged from a mean of 15 minutes for a consultant in acute medicine to a mean of 55 minutes for a foundation year 1 trainee. The duration of post-take ward rounds also showed signifi cant variability. Our data can be used to model staffi ng patterns if combined with information about admission numbers and local set up.

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“…Given the high proportion of time that doctors are already spending on documentation, design and evaluation need to focus on using patient inputs in an efficient manner. 20,21 Some of the benefits from usage of PHRs outside of hospital can be translated for inpatient usage. Development of tailored user interfaces for the specific tasks in acute care will require prospective testing in multicentre studies with capture of clinical outcomes, patient and staff satisfaction and cost implications.…”

Section: Discussionmentioning

confidence: 99%

Scenario-based design for a hospital setting: An exploratory study of opportunities and barriers for personal health records usage

Pearson

Wischhusen

Hibbs³

et al. 2020

Future Healthcare Journal

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Personal health records (PHRs) offer patients the opportunity to be more actively involved in their own care. There is limited research into the application during hospital admissions for elective or emergency presentations. We used techniques from scenario-based design to test the opportunities and boundaries of a commercially available PHR in a simulated environment. Scenarios included a patient in his 80s admitted for hip surgery with his son, and a younger patient admitted with pneumonia. A catastrophic deterioration was demonstrated with a mannequin in a highfidelity simulation. Workflows were summarised in swim-lane diagrams. The PHR allowed patients to file information prior to the interaction with the clinical team. This led to shorter time requirements for acquisition of data. The elderly patient required assistance from a relative but this aided verification of history prior to the encounter with the clinical team. Ward rounds could be prepared by the patient with specific 'what matters' questions. Documentation in the PHR environment during a simulated life-threatening emergency did not result in information that was unintelligible or useful for the 'patient'. Usage of a commercially available PHR during hospital admission is feasible and might aid workflow. Documentation of emergencies might require different documentation formats.

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Safety in numbers: lack of evidence to indicate the number of physicians needed to provide safe acute medical care

Cited by 11 publications

References 33 publications

The association between physician staff numbers and mortality in English hospitals

The association between physician staff numbers and mortality in English hospitals

‘The time it takes…’ How doctors spend their time admitting a patient during the acute medical take

Scenario-based design for a hospital setting: An exploratory study of opportunities and barriers for personal health records usage

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