Turning Over Patient Turnover: An Ethnographic Study of Admissions, Discharges, and Transfers

• Type of Material: Article
• Authors: Bonnie M. Jennings, Emory University; Margarete Sandelowski, University of North Carolina; Cary C. Boshamer, University of North Carolina; Melinda K Higgins, Emory University
• Language: English
• Date: 2013-12-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/nur.21565
• Title of Journal or Parent Work: Research in Nursing and Health
• ISSN: 0160-6891
• Volume: 36
• Issue: 6
• Start Page: 554
• End Page: 566
• Grant/Funding Information: This publication was supported by a postdoctoral fellowship in Health care Quality & Patient Outcomes awarded by the National Institute of Nursing research/National Institutes of Health to the University of North Carolina at Chapel Hill School of Nursing, North Carolina, USA (2T32NR008856, 2009-2014 Barbara Mark, Director).
• Keywords: interruptions; MEDICATION ADMINISTRATION ERRORS; HANDOFFS; SAFETY; Nursing; TURBULENCE; ACUTE-CARE; Life Sciences & Biomedicine; INTERRUPTIONS; SCIENCE; Science & Technology; health care quality; nursing workload; patient turnover; patient safety; ethnography; OUTCOMES; quality; NURSES; WORK
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

The impact on nursing work of patient turnover (admissions, discharges, and transfers) became evident in an ethnographic study of turbulence. The patient turnover data were generated from extensive observations, 21 formal interviews, and a year of admission and discharge records on one medical and one surgical unit. Timing of turnover events on the two units differed, but on both units admissions typically interrupted workflow more than did discharges, clustered admissions were more disruptive than staggered admissions, and patient turnover during change of shift was more disruptive than during medication administration. Understanding the complexity of patient turnover will elucidate the work involved and improve the evidence base for nurse staffing, a key determinant of quality and safety of care.