Sean Gregory

Bedside Shift Reports: What Does the Evidence Say?

Bedside shift reports are viewed as an opportunity to reduce errors and important to ensure communication between nurses and communication. Models of bedside report incorporating the patient into the triad have been shown to increase patient engagement and enhance caregiver support and education. Nurse shift reports and nurse handovers are 2 of the most critical processes in patient care that can support patient safety and reduce medical errors in the United States. Nurses continue to not recognize the evidence supporting this practice and adopt bedside report into practice.

Burnout Among Primary Care Physicians: A Test of the Areas of Worklife Model.

EXECUTIVE SUMMARY Examinations of the current state of the physician workforce, in the United States and globally, indicate a declining overall well‐being, and specifically increasing levels of burnout. The consequences of these effects include early retirements or exits from the medical profession, difficulties improving the patient experience, and low levels of provider engagement with clinic‐level and system‐level initiatives. Such consequences affect physicians, healthcare organizations, and patients. While most research has focused on identifying burnout, cataloging its effects, and creating a case for attending to its impact, relatively few studies have focused on exploring the antecedents of burnout for physicians. The goal of this study was to test an etiological model, the Areas of Worklife Scale (AWS), for practicing primary care physicians. Using the AWS and the Maslach Burnout Inventory, the study used a longitudinal survey research design method to query primary care physicians employed at a large integrated delivery system in the United States. Data collected successfully fit the AWS model for burnout among primary care physicians, supporting our theory that workplace drivers are responsible for burnout. Workload, control, and values congruence are the largest drivers of burnout for practicing primary care physicians. The AWS model provides key insights into the domains of work that cause stress and ultimately burnout for physicians, and these domains can guide physicians and managers to develop interventions to fight the rising incidence of burnout.

Rates of cholesterol screening of youth.

Our findings complement those of both Ray et al2 and Svanström et al3 despite being quite different on the surface. Our hypothesis is that the divergent results are due to the populations studied and the antibiotic prescribing patterns for those populations. The study by Ray et al2 included only Tennessee Medicaid outpatients, many of whom potentially had no indication for antibiotic therapy and therefore no benefits to accrue. The study by Svanström et al3 included patients aged 18 to 64 years in Denmark, a younger and healthier population in a country with lower rates of inappropriate antibiotic prescribing.4 Our study only included older patients hospitalized with pneumonia, a population that has an approximately 15% risk of death and greater than 12% risk of at least 1 cardiovascular event5 within 90 days after admission and potentially has much to gain from the appropriate use of antibiotics. For those patients without an appropriate indication for antibiotics, no antibiotic, including azithromycin, should be prescribed. However, for those with bacterial infections for which azithromycin is considered appropriate, until there is consistent and convincing evidence otherwise, this medication should be considered a safe and effective therapy.

Identifying and Reducing Barriers to Improve Lipid Screening in Youth

Despite numerous published pediatric guidelines over the past two decades, little has changed in the way providers screen children for dyslipidemia. The acuity of this problem is most notable in youth likely to have heterozygous familial hypercholesterolemia (FH), one of the most common inherited diseases with a prevalence greater than all congenital defects that newborns are routinely screened for in the US. Because heterozygous FH is underdiagnosed in most countries there is a need to identify barriers and solutions to improve lipid screening in youth. This review summarizes different approaches to lipid screening and how point-of-care lipid testing may be used to improve screening.

The influence of organization tenure on nurses' perceptions of multiple work process improvement initiatives.

BACKGROUNDnA nurses optimism or skepticism toward an organization-mandated change initiative largely depends on their experience with similar change initiatives and their units and organizations track record with previous change efforts. Thus, depending on the context, organization tenure can work in favor or against any particular change initiative. However, few studies have examined the impact of organization tenure on perceptions toward change initiatives. The few studies that have been conducted have yielded mixed results and have only targeted single or similar work initiatives.nnnPURPOSEnThe aim of this study was to examine how organization tenure impacts nurses perceptions toward a diverse array of work process improvement initiatives.nnnMETHODOLOGYnThe data are derived from a survey of 421 medical-surgical nurses representing 41 units across four hospitals. The survey was designed to capture nurses perceptions toward three change initiatives-AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank You), hourly rounding, and discharge phone calls-and their impact across two subscales-patient care and individual work change.nnnFINDINGSnOrganization tenure is significantly and negatively associated with change receptivity for the non-patient safety-oriented initiative (AIDET). This negative relationship dissipates as we evaluate more patient safety-oriented work process initiatives (hourly rounding and discharge phone calls).nnnPRACTICE IMPLICATIONSnSignificant differences in nurses perceptions toward change do exist depending on how long they have worked for their employer. For non-patient safety-oriented change initiatives, veteran-to-the-organization nurses may exhibit more recalcitrance than their new-to-the-organization counterparts. However, our findings also suggest the presence of a patient safety exception rule where veteran-to-the-organization nurses do not exhibit differences in opinion than their new-to-the-organization counterparts for patient safety-oriented change initiatives.

Improving Physician Well-Being

viously studied. Nearly 40% of the study population consisted of patients with non–ST-segment elevation myocardial infarction, where early PCI for high-risk patients is associated with a mortality benefit and is recommended by the American College of Cardiology Foundation/American Heart Association guidelines.4 Yet, there was no overall difference in mortality across the PCI strategies. This is perhaps explained by the fact that FFR and IVUS are only adjunctive devices used to guide and/or facilitate PCI, which is the ultimate interventional therapy in question. In addition, the patient population also significantly differed in the degree of intermediate coronary stenosis (7.5% in the angiography group had stenosis <75% as opposed to 38.7% in the FFR group and 18.5% in the IVUS group),1 which may influence the baseline risk of mortality. Therefore, comparing outcomes in these highly heterogenous groups is fraught with risk, despite careful attempts by the authors to minimize confounding using propensity matching. Finally, we should be cognizant that while FFR and IVUS are available to guide PCI, the most important determinants of PCI in patients with stable coronary disease are still patients’ symptoms on maximal medical therapy and shared decision making, where patients understand that PCI is only an option to treat symptoms and not an attempt to extend life. Fractional flow reserve may further have a role in deferring PCI in appropriate patients, with either intermediate or obstructive coronary stenosis on angiography, and nonhemodynamically significant lesions.5 Because outcomes of patients in whom PCI was deferred based on FFR or IVUS was not captured by this registry, benefic ial outcomes may be underestimated.1 Ultimately, if judicious use of FFR or IVUS in carefully selected patients can decrease the volume of PCI without adversely impacting symptom control, then “less is more.”