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  • 1
    Online Resource
    Online Resource
    Cross-Cover Documentation: Multicenter Development of Assessment Tool for Quality Improvement
    Informa UK Limited ; 2019
    In:  Teaching and Learning in Medicine Vol. 31, No. 5 ( 2019-10-20), p. 519-527
    Details
    In: Teaching and Learning in Medicine, Informa UK Limited, Vol. 31, No. 5 ( 2019-10-20), p. 519-527
    Type of Medium: Online Resource
    ISSN: 1040-1334 , 1532-8015
    URL: Article
    DOI: 10.1080/10401334.2019.1583567
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2019
    SSG: 5,3
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  • 2
    Online Resource
    Online Resource
    Inpatient Cross-Cover Consensus Recommendations for Medical and Surgical Residents: A Delphi Analysis
    Journal of Graduate Medical Education ; 2019
    In:  Journal of Graduate Medical Education Vol. 11, No. 3 ( 2019-06-01), p. 277-283
    Details
    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
    URL: Article
    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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  • 3
    Online Resource
    Online Resource
    Implementation of an Electronic Health Record Intervention to Improve Resident Documentation and Communication about Overnight Cross-Cover Events
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  American Journal of Medical Quality Vol. 37, No. 4 ( 2022-07), p. 371-372
    Details
    In: American Journal of Medical Quality, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 4 ( 2022-07), p. 371-372
    Type of Medium: Online Resource
    ISSN: 1062-8606
    URL: Article
    DOI: 10.1097/JMQ.0000000000000058
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2181248-2
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  • 4
    Online Resource
    Online Resource
    Can Incoming Interns Be Entrusted to Recognize Medical Emergencies? Implementation of a Vignette-Based Cross-Cover Assessment
    Journal of Graduate Medical Education ; 2022
    In:  Journal of Graduate Medical Education Vol. 14, No. 4 ( 2022-08-01), p. 488-492
    Details
    In: Journal of Graduate Medical Education, Journal of Graduate Medical Education, Vol. 14, No. 4 ( 2022-08-01), p. 488-492
    Abstract: Interns must recognize urgent clinical situations and know when to seek assistance. However, assessing this skill is challenging. Objective We explored whether graduating medical students could determine urgency of medical cross-cover scenarios and what factors were associated with this ability. Methods Sixty senior medical students enrolled in an internal medicine residency preparation course, and 28 experts were invited to take an assessment using 4 clinical vignette handoffs, each with 5 to 6 cross-cover scenarios. Respondents were asked whether they would evaluate the patient at bedside and notify their supervising resident. They were asked to rate their comfort managing the scenario, rate the urgency (1=low, 2=moderate, 3=high), and take a medical knowledge quiz. Student performance was categorized based on stratification of clinical urgency—those who underestimated (fourth quartile), accurately estimated (second and third quartile), and overestimated (first quartile) urgency. We examined differences between groups in medical knowledge, action, and confidence using analysis of variance and post-hoc Tukey Honestly Significant Difference test. Results Fifty-eight students (96.7%) and 22 experts (78.6%) participated. Clear differentiation emerged between students' ability to estimate urgency on the 3-point urgency scale (lowest quartile: 2.15±0.11; mid-quartiles: 2.38±0.07; upper quartile: 2.61±0.10, respectively). Students who underestimated urgency were less likely to notify their supervising resident (P=.001) and less likely to evaluate a patient at bedside (P=.01). There was no difference in quiz score or comfort level. Conclusions Incoming interns vary in their abilities to recognize urgent scenarios, independent of medical knowledge and confidence.
    Type of Medium: Online Resource
    ISSN: 1949-8357 , 1949-8349
    URL: Article
    DOI: 10.4300/JGME-D-21-01193.1
    Language: English
    Publisher: Journal of Graduate Medical Education
    Publication Date: 2022
    detail.hit.zdb_id: 2578612-X
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  • 5
    Online Resource
    Online Resource
    Are medical students trained in cross‐cover?
    Wiley ; 2019
    In:  The Clinical Teacher Vol. 16, No. 3 ( 2019-06), p. 214-219
    Details
    In: The Clinical Teacher, Wiley, Vol. 16, No. 3 ( 2019-06), p. 214-219
    Abstract: To examine the current state of cross‐cover education in undergraduate medical education and intern perceived readiness to provide cross‐cover. Methods An electronic survey was distributed to 126 incoming interns in surgery, internal medicine, family medicine and paediatrics residencies at a single academic centre. Information regarding prior cross‐cover training, experience, confidence, and responses to a sample cross‐cover case were obtained. Results The survey response rate was 69.8% (88 of 126), which included both partial and complete responses. Fifty‐seven interns out of 85 (67.1%) had no formal training and 51 (60.0%) had no experience performing cross‐cover. They reported feeling unprepared to provide cross‐cover, with an average score of 1.8 on a 5‐point Likert scale (1, not at all confident; 5, extremely confident). Interns had more confidence in performing cross‐cover tasks if they had prior direct cross‐cover experience (p = 0.001), and were the least confident in performing the initial evaluation and management of urgent issues (Likert score = 1.6). Scores on the sample case were correlated with the amount of prior experience with patients (p = 0.06). Only 77.7% of interns indicated that they would notify their senior resident in two urgent scenarios. Those who reported higher confidence in knowing when to ask for help were more likely to appropriately notify their senior colleague (p = 0.005). We identified gaps in cross‐cover training and in the preparedness of incoming interns Conclusions We identified gaps in cross‐cover training and in the preparedness of incoming interns. This has important implications for the first day of residency, when interns are often asked to perform cross‐coverage, yet feel unprepared to do so and express the greatest concern in urgent cross‐cover scenarios. Addressing this curricular gap is crucial in assuring safe cross‐cover care.
    Type of Medium: Online Resource
    ISSN: 1743-4971 , 1743-498X
    URL: Issue
    URL: Article
    DOI: 10.1111/tct.2019.16.issue-3
    DOI: 10.1111/tct.12803
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2174501-8
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  • 6
    Online Resource
    Online Resource
    The power of written word: Reflection reduces errors of omission
    Wiley ; 2023
    In:  The Clinical Teacher
    Details
    In: The Clinical Teacher, Wiley
    Abstract: Medical trainees are expected to perform complex tasks while experiencing interruptions, which increases susceptibility to errors of omission. In our study, we examine whether documentation of clinical encounters increases reflective thinking and reduces errors of omission among novice learners in a simulated setting. Methods In 2021, 56 senior medical students participated in a simulated paging curriculum involving urgent inpatient cross‐cover scenarios (sepsis and atrial fibrillation). Students responded to pages from standardized registered nurses (SRNs) via telephone, gathered history, and discussed clinical decision‐making. Following the phone encounter, students documented a brief note (documentation encounter). A ‘phone’ score (number of checklist items completed in the phone encounter) and a ‘combined’ score (number of checklist items completed in the phone and documentation encounters) were calculated. Data were analyzed for differences between the phone scores (control) and combined scores using T‐tests and McNemar test of symmetry. Findings Fifty‐four students (96%) participated. Combined scores were higher than phone scores for sepsis (72.8 ± 11.3% vs. 67.9 ± 11.9%, p  〈  0.001) and atrial fibrillation (74.0 ± 10.1% vs. 67.6 ± 10.0%, p  〈  0.001) cases. Important items, such as ordering blood cultures for sepsis (p = 0.023) and placing the patient on telemetry for atrial fibrillation (p = 0.013), were more likely to be present when a note was documented. Discussion This study suggests that documentation provides a mechanism for learners to reflect, which could increase important diagnostic and therapeutic interventions. Conclusion Documentation by novice medical learners may improve patient care by allowing for reflection and reducing errors of omission.
    Type of Medium: Online Resource
    ISSN: 1743-4971 , 1743-498X
    URL: Article
    DOI: 10.1111/tct.13630
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2174501-8
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