Doctors may overestimate the quality of care they provide

Caregivers failed to recognize patient care delays in small, Dutch study

A small new study finds that hospital physicians and nurses often fail to recognize delays in patient care, suggesting a disconnect between care quality and providers' perceptions of care quality.

The Dutch study, published in Critical Care Medicine, included records of 47 patients who received CPR or were admitted to the ICU between April and July 2009, as well as interviews with 198 nurses and physicians.

Overall, the researchers identified 38 instances in which a patient should have been considered "at risk" in the two days leading up to serious complications. However, they found that in 60% of the cases, there was a delay in clinicians' recognition that the patient had deteriorated.  Moreover, physicians and nurses failed to recognize that there had been a delay in most of those cases.

In addition, the researchers found that nurses and physicians gave themselves high ratings for their abilities to detect a patient's deteriorating condition, to communicate, and to coordinate patient care.

Based on the findings, the researchers determined that physicians and nurses may overestimate the quality of the care they provide hospital patients in the days leading to serious complications. 

Commenting on the study, University of Pittsburgh School of Medicine professor Jeremy Kahn said, "Individual clinicians, when confronted with an adverse error that they may be responsible for, are relatively unlikely to allow themselves to think critically about their care.

He said the study should provide a "value lesson" and shows that "there are more important steps that need to be taken to ensure a cultural change" (Seaman, Reuters, 9/4).

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