Browsing by Subject "Patient Outcomes"

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    Decision fatigue in hospital medicine: A scoping review
    (The Society for Hospital Medicine, 2024-04) Jones, Sarah; Perry, Kelsey; Stumpff, Julia C.; Kruer, Rachel; Czosnowski, Lauren; Kara, Areeba
    BACKGROUND: Decision fatigue describes the erosion of decision-making capacity as a consequence of the repeated acts of decision making. The phenomenon has been detected in ambulatory settings with higher rates of inappropriate antimicrobial and opiate prescribing and lower rates of cancer screening associated with appointments that occur later in the day. As hospital medicine is acknowledged to be a cognitively intense specialty, we decided to explore decision fatigue in hospital medicine. METHODS: As a relatively unexplored concept, we undertook a scoping review to understand what is known about decision fatigue in hospital medicine. All studies including healthcare workers in acute care settings and exploring the concepts of decision fatigue, cognitive burden and/or fatigue were included. Conceptually related studies of sleep deprivation, shift work, Circadian disruption, and excessive workloads with actual or theoretical paths of causality related to patient outcomes were also included. RESULTS: Our preliminary search revealed fifteen studies that met our inclusion criteria. No study specifically included hospitalists. Most studies described the concept among nurses, residents, and/or emergency department physicians. The outcomes studied were diverse and included self reported perceptions (e.g. perceived impact on patient care) and validated scales to measure fatigue and psychomotor performance. Fewer studies investigated clinical decisions such as the use of consultations, imaging and disposition decisions through the emergency department. Mitigating circumstances such as age, experience, responsibilities outside the hospital (e.g. having children) were infrequently described. CONCLUSIONS: While hospital medicine's fast pace, multitasking, fragmentation between clinicians and interruptions make it susceptible to decision fatigue, the concept remains under-explored in hospital medicine. The lack of consistent terminology complicates the evaluation of a phenomenon which ultimately is the culmination of individual, patient, work system and work environment factors. There is a need to detect and defuse the impact of decision fatigue in hospital medicine.
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    An Examination of the Relationships among Nurses’ Work Environment, Nurses’ Education Level and Patient Outcomes
    (Office of the Vice Chancellor for Research, 2016-04-08) Broughton, Lisa
    This study sought to address the gap that exists in the empirical literature regarding the relationships among nurses’ education level, the nursing work environment, and nursingsensitive patient outcomes. This study was a secondary data analysis of data from sixteen units in a Magnet recognized, urban, teaching center in a large health system. Variables included nurse education level, characteristics of the nursing work environment, obtained through the Practice Environment Scale of the Nursing Work Index (PES-NWI) survey results, and the nursingsensitive patient outcomes of falls, hospital acquired pressure ulcers, catheter-associated urinary tract infections (CAUTI), central line-associated blood stream infections (CLABSI), and ventilator-associated pneumonia (VAP). Data were analyzed using path analysis to determine correlations among the hypothesized relationships between variables. The results of the study indicate that although significant correlations were seen between nurse education level, variables within the nursing work environment, and nursing-sensitive outcomes, the effect of nurse education level on nursing-sensitive outcomes is almost entirely made up of a direct effect. The indirect effect of nurse education level through the PES-NWI total score and subscale scores was minimal for all nursing-sensitive patient outcomes. There was strong evidence to suggest that nurse education level was associated with lower rates of falls and CLABSI.