In:
Journal of Graduate Medical Education, Journal of Graduate Medical Education, Vol. 11, No. 3 ( 2019-06-01), p. 277-283
Abstract:
Residents regularly care for hospitalized patients for whom they are not the primary provider (cross-cover), often without guidance. Objective We identified and defined components of safe cross-cover care. Methods Sixty medical and surgical faculty physicians and chief residents from the Midwest were invited to participate in a Delphi study analyzing the appropriateness of cross-covering residents evaluating patients at bedside, deferring issues to the primary team, documenting a note, contacting the attending, and communicating with nurses. The first survey was free text, and responses were categorized. In the second survey, physicians rated categorized responses based on appropriateness using a 5-point Likert scale. High consensus was defined as ≥ 80% agreement, approaching consensus as 51% to 79% agreement, and nonconsensus as ≤ 50% agreement. Results were analyzed by specialty and cross-cover experience in the past year using Pearson χ2 test or Fisher exact test. Results Forty respondents (67%) completed the first survey and 30 (50%) completed the second. Responses led to 46 categories. Twenty-eight items (60%) achieved high consensus, 8 (17%) approached consensus, and 10 (22%) did not achieve consensus, with no difference based on specialty or experience. Responses with 100% consensus included: residents should evaluate a patient at bedside whenever asked by the nurse; documentation should occur for change in level of care, death, code, or rapid response team activation; and physician-nurse communication should be respectful and closed loop. Conclusions This regional physician panel reached consensus on 28 elements important in cross-cover care, which can be used for training and future studies.
Type of Medium:
Online Resource
ISSN:
1949-8349
,
1949-8357
DOI:
10.4300/JGME-D-18-00707.1
Language:
English
Publisher:
Journal of Graduate Medical Education
Publication Date:
2019
detail.hit.zdb_id:
2578612-X
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