Patient Care

Social, System Factors Can Influence Decisions to Continue Patient Care


 

Clinical question: Why do healthcare providers work while sick?

Background: Healthcare providers generally are aware of the risks of infection to hospitalized patients; however, despite this knowledge, several studies have revealed providers continue to work while ill.

Study design: Mixed-method analysis of a cross-sectional survey.

Setting: Large academic children’s hospital.

Synopsis: Investigators completed 538 of 929 surveys of attending physicians and advanced practice clinicians (APCs), a response rate of 58%. Of the respondents, 95% agreed that sick providers continuing patient care increased their patients’ risk for infection; however, 83% admitted to caring for patients while sick, with physicians being more likely to do so.

Several factors contributed to this behavior, including fear of letting colleagues or patients down, fear of ostracism by colleagues, and concerns for understaffing or discontinuity of care. Qualitative analysis of free-text responses revealed additional factors, including the difficulty of finding sick coverage, the strong cultural norms to continue working unless severely ill, and the ambiguity of defining “too sick to work.”

Limitations of this study included possible response bias, lack of a validated survey, and inclusion of only a single center; however, results confirm prior studies and reveal additional systems factors that hospital leadership could address, supporting providers and improving patient care.

Bottom line: Sick healthcare providers face several challenges that drive them to put their patients at risk by continuing patient care, and these factors could be addressed by healthcare systems as a means of improving overall quality of care.

Citation: Szymczak JE, Smathers S, Hoegg C, Klieger S, Coffin SE, Sammons JS. Reasons why physicians and advanced practice clinicians work while sick: a mixed-methods analysis. JAMA Pediatr. 2015;169(9):815-821. doi:10.1001/jamapediatrics.2015.0684.

Hospitalists as Test Subjects

NO BENEFIT TO ROUTINE SCREENING WITH CT TO EVALUATE FOR OCCULT CANCER IN UNPROVOKED VTE

In this randomized controlled trial, prevalence of occult malignancy was low among patients with a first unprovoked VTE, and adding comprehensive CT of the abdomen and pelvis to a limited cancer screening strategy did not lead to fewer missed cancers.

Citation: Carrier M, Lazo-Langner A, Shivakumar S, et al. Screening for occult cancer in unprovoked venous thromboembolism. New Engl J Med. 2015;373(8):697-704. doi:10.1056/NEJMoa1506623.


OBSTRUCTIVE SLEEP APNEA NOT A CAUSE OF CLINICAL DETERIORATION OR IN-HOSPITAL MORTALITY IN POST-OPERATIVE PATIENTS

Observational, cohort study showed that post-operative patients with obstructive sleep apnea did not have an increased risk of clinical deterioration or in-hospital mortality.

Citation: Lyons PG, Zadravecz FJ, Edelson DP, Mokhlesi B, Churpek MM. Obstructive sleep apnea and adverse outcomes in surgical and nonsurgical patients on the wards. J Hosp Med. 2015;10(9):592-598. doi: 10.1002/jhm.2404.


RESTRICTING NON-PROTEIN CALORIES IN CRITICALLY ILL PATIENTS DOES NOT AFFECT MORTALITY

A multi-centered randomized controlled trial of 894 critically ill adults found no mortality benefit for patients receiving nonprotein calorie restriction (permissive underfeeding) vs. standard enteral feeding.

Citation: Arabi YM, Aldawood AS, Haddad SH, et al. Permissive underfeeding or standard enteral feeding in critically ill adults. N Engl J Med. 2015;372(25):2398-2408.


NEW AGENT EFFECTIVE IN RAPID DABIGATRAN REVERSAL

Prospective cohort study showed that idarucizumab completely reverses the anticoagulant effect of dabigatran within minutes, based on serial measurements of dilute thrombin time and ecarin clotting time.

Citation: Pollack CV II, Reilly PA, Eikelboom J, et al. Idarucizumab for dabigatran reversal. New Engl J Med. 2015;373(6):511-520.


RISK OF ARTHROSCOPIC KNEE SURGERY GREATER THAN BENEFIT

Systematic review and meta-analysis demonstrated that adults with and without radiographic osteoarthritis only had limited short-term benefit from arthroscopy, with greater associated short- and long-term harm.

Citation: Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ. 2015;350:h2747.

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