The management of adverse clinical events in nursing homes: a 1-year survey study.
OBJECTIVE
In Italian nursing homes (NHs), care delivery at night and during holidays is not regulated by regional laws; some facilities employ staff physicians, others employ physicians engaged from year to year (temporary physicians), and others employ publicly funded National Health System (NHS) physicians. This study was designed to determine whether the use of different kinds of physicians leads to different outcomes with regard to the rate of hospitalization and appropriateness of the management of adverse clinical events.


METHODS
Prospective, nonrandomized-survey data collection.


METHODS
Ten nonprofit nursing facilities in Italy.


METHODS
Three hundred and fifty-two NH residents, staff physicians, temporary physicians, and NHS physicians.


METHODS
Medical intervention during adverse clinical events occurring at night and during holidays.


RESULTS
Three hundred and fifty-two residents experienced 551 adverse clinical events; 78 were hospitalized. The hospitalization rate of NHS physicians was about two times that of the temporary physicians and six times that of the staff physicians. Staff physicians' diagnoses and management were appropriate in the majority of cases; NHS diagnosis and management were doubtful or incorrect in about one-third of all cases.


CONCLUSIONS
NH residents frequently experience adverse clinical events; physician characteristics influence the rate of hospitalization and the quality of medical interventions.
Bellelli
G
G
Geriatric Research Group, Brescia, Italy.
Frisoni
G B
GB
Barbisoni
P
P
Boffelli
S
S
Rozzini
R
R
Trabucchi
M
M
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004358:Drug Therapy / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D015577:Geriatric Assessment; D006302:Health Services Research; D006693:Holidays; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008503:Medical Staff / Q000458:organization & administration*; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D009551:Night Care; D009735:Nursing Homes / Q000458:organization & administration; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D015995:Prevalence; D011446:Prospective Studies; D011787:Quality of Health Care; D000078329:Workforce