BACKGROUND: 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.
BACKGROUND: 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.
Authors: Kevin J O'Leary; J A Thompson; M P Landler; N Kulkarni; C Haviley; K Hahn; J Jeon; D B Wayne; D W Baker; M V Williams Journal: Qual Saf Health Care Date: 2010-04-29
Authors: Elie A Akl; Anshu Bais; Ellen Rich; Joseph Izzo; Brydon J B Grant; Holger J Schünemann Journal: J Gen Intern Med Date: 2006-05 Impact factor: 5.128
Authors: Sanjay V Desai; Leonard Feldman; Lorrel Brown; Rebecca Dezube; Hsin-Chieh Yeh; Naresh Punjabi; Kia Afshar; Michael R Grunwald; Colleen Harrington; Rakhi Naik; Joseph Cofrancesco Journal: JAMA Intern Med Date: 2013-04-22 Impact factor: 21.873