title: In-hospital fellow coverage reduces communication errors in the surgical intensive care unit.
abstract: BACKGROUND
  Staff coverage strategies of intensive care units (ICUs) impact clinical outcomes. High-intensity staff coverage strategies are associated with lower morbidity and mortality. Accessible clinical expertise, team work, and effective communication have all been attributed to the success of this coverage strategy. We evaluate the impact of in-hospital fellow coverage (IHFC) on improving communication of cardiorespiratory events.
  
  
  METHODS
  A prospective observational study performed in an academic tertiary care center with high-intensity staff coverage. The main outcome measure was resident to fellow communication of cardiorespiratory events during IHFC vs home coverage (HC) periods.
  
  
  RESULTS
  Three hundred twelve cardiorespiratory events were collected in 114 surgical ICU patients in 134 study days. Complete data were available for 306 events. One hundred three communication errors occurred. IHFC was associated with significantly better communication of events compared to HC (P<.0001). Residents communicated 89% of events during IHFC vs 51% of events during HC (P<.001). Communication patterns of junior and midlevel residents were similar. Midlevel residents communicated 68% of all on-call events (87% IHFC vs 50% HC, P<.001). Junior residents communicated 66% of events (94% IHFC vs 52% HC, P<.001). Communication errors were lower in all ICUs during IHFC (P<.001).
  
  
  CONCLUSIONS
  IHFC reduced communication errors.
authors: Department of Surgery, University of Toledo Medical Center, Toledo, OH. Electronic address: mw1906@yahoo.com.
authors: Mallory
authors: M
authors: Williams
authors: Department of Surgery, Orlando Regional Medical Center, Orlando, FL.
authors: Rodrigo F
authors: RF
authors: Alban
authors: Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors: James P
authors: JP
authors: Hardy
authors: Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
authors: David A
authors: DA
authors: Oxman
authors: Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors: Edward R
authors: ER
authors: Garcia
authors: Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors: Nathanael
authors: N
authors: Hevelone
authors: Department of Anesthesia, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors: Gyorgy
authors: G
authors: Frendl
authors: Department of Surgery, Temple University Hospital, Philadelphia, PA.
authors: Selwyn O
authors: SO
authors: Rogers
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D003142:Communication; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D000860:Hypoxia / Q000453:epidemiology; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D008875:Middle Aged; D062209:Patient Handoff; D010561:Personnel Staffing and Scheduling; D011446:Prospective Studies; D013514:Surgical Procedures, Operative; D059246:Tachypnea / Q000453:epidemiology
keywords: Communication; Fellow; Intensive Care Unit; Resident