No wonder there are so many dx errors - The average clinic visit is 5 minutes !

Ruth Ryan ruth at RYAN-GRAHAM.COM
Thu Nov 9 19:14:43 UTC 2017


Mark and all,

Very interesting!  Short PCP visits related to a lesser degree of care, worse patient outcomes and reduced satisfaction on the part of the physician.

It’s “Normalization of Deviance” on a global scale.

This parallels the more detailed findings from the Aiken et al studies about nurse time and training, linking less favorable nurse-to-patient ratios and less educated nurses to increased patient death rates. This has been quantified.  For at least the last 15 years it has been known that adding to a nurse’s standard work load raises the patient mortality rate 7% per patient added (Aiken et al, 2002).  Also it’s associated with increased rates of nurse burnout and dissatisfaction.  Other than the California nurse:patient ratio law, won by labor unions more than QI efforts, nothing has been done about this in all these years. As with physicians, the coming of the user-unfriendly EHR has also had the effect of taking nurses away from the bedside and adding to their administrative burden.

In all the literature and all the QI efforts for the past 20 years about preventing medical mistakes and reducing diagnostic error, I don’t believe this elephant in the room has been much addressed. It’s mostly taken for granted as part of the landscape.

  *   Aiken LH1, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002 Oct 23-30;288(16):1987-93.
  *   Aiken LH, Cimiotti JP, Sloane DM, Smith HL, Flynn L, Neff DF. The Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments. Medical care. 2011;49(12):1047-1053. doi:10.1097/MLR.0b013e3182330b6e.
  *   Aiken LH, Clarke SP, Sloane DM, et al. Effects of hospital care environments on patient mortality and nurse outcomes. J Nurs Adm. 2008;38:220–226.
  *   Aiken LH, Clarke SP, Sloane DM, et al. Hospital nurse staffing and patient mortality, nurse burnout and job dissatisfaction. JAMA. 2002;288:1987–1993.
  *   Aiken LH, Clarke SP, Cheung RB, et al. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003;290:1617–1623.
  *   Kendall-Gallagher D, Aiken LH, Sloane DM, et al. Nurse specialty certification, inpatient mortality, and failure to rescue. J Nurs Scholarsh. 2011;43:188–194.

Ruth

Ruth Ryan
Planning Committee Chair/DEM2018
Secretary/SIDM Board of Directors
Telephone (504) 256-8797
Email ruth at ryan-graham.com<mailto:ruth at ryan-graham.com>
Save the Date: Diagnostic Error in Medicine Conference, November 4-6, 2018, New Orleans LA
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From: Mark Graber [mailto:graber.mark at GMAIL.COM]
Sent: Thursday, November 09, 2017 10:34 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] No wonder there are so many dx errors - The average clinic visit is 5 minutes !

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Mark L Graber MD FACP
President, SIDM
Senior Fellow, RTI International
Professor Emeritus, Stony Brook University
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