A qualitative analysis of clinical decompensation in the surgical patient: Perceptions of nurses and physicians

There is little knowledge on how health care providers individually interpret and communicate early warning signs to other providers. The aim of the study described here was to qualitatively assess the similarities and differences in how nurses and physicians perceive early warning signs that potentially predict clinical decompensation, changes in clinical acuity in surgical patients, and need for escalation of care.

Ethnographic interviews were conducted with nurses, surgical residents, and attending surgeons on an acute care medical-surgical unit. Constant comparative analysis was used to analyze and draw conclusions from the interview data.

There were many areas of strong agreement across all care providers including the same data analyzed, importance of temporal trends, and lower acuity level for an established patient. However, physicians differed from nurses in that their primary indicator of patient stability was their level of confidence in the current diagnosis. Nurses, however, deemed patients to be stable only when their symptoms resolved. Other differences were the methods and frequency they used to monitor unstable patients.

Differences in the type of communication and clinician's mental models of acuity and stability could lead to coordination failures and adverse events. Understanding and addressing these differences has the potential to improve outcomes.