Taking a detour: positive and negative effects of supervisors' interruptions during admission case review discussions.

https://arctichealth.org/en/permalink/ahliterature121363
Source
Acad Med. 2012 Oct;87(10):1382-8
Publication Type
Article
Date
Oct-2012
Author
Mark Goldszmidt
Natasha Aziz
Lorelei Lingard
Author Affiliation
Division of General Internal Medicine, Department of Medicine, University of Western Ontario, Schulich School of Medicine and Dentistry, London, Ontario, Canada. Mark.Goldszmidt@schulich.uwo.ca
Source
Acad Med. 2012 Oct;87(10):1382-8
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Documentation
Education, Medical, Undergraduate
Hospitals, University - organization & administration
Humans
Internal Medicine
Internship and Residency
Interprofessional Relations
Ontario
Patient Admission
Patient Care Team - organization & administration
Abstract
During admission case review, teams work to develop a shared understanding of the problems they need to address during the patient's hospitalization. However, research on the effects of the case review on patient care is limited. Informed by rhetorical genre theory, the authors explored the impact of team's communication practices on the comprehensiveness of the case review.
Using a multiple-case-study approach, the authors in 2010 observed in person, audio-recorded, and transcribed data from overnight and morning case review discussions for 19 patient cases in the internal medicine department of an academic medical center. They also extracted data from the corresponding admission notes. They used a constant-comparison approach to identify emerging themes within and across cases.
The authors identified detours, which typically arose from supervisors' interruptions, in all 19 cases. They identified five detour types: pausing the presentation, referring to a section later in the presentation, presenting sections out of sequence, skipping a section, and truncating the presentation. Although supervisors' interruptions during case review discussions allowed for teaching and patient care, they also created detours from the usual case presentation, which then could lead to the omission of relevant case details.
Supervisors' interruptions during case review discussions can lead to detours, which simultaneously afford valuable opportunities for teaching and threaten comprehensive information sharing. Future research should explore detours in other teaching settings to better understand their positive, negative, and unintended consequences for patient care.
PubMed ID
22914516 View in PubMed
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