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

Authors

  • Bonnie Mowinski Jennings,

    Corresponding author
    1. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
    • Correspondence to: Bonnie Jennings, 4211 Sutter's Court Evans, GA 30809.

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    • Professor.
  • Margarete Sandelowski,

    1. University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC
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    • Cary C. Boshamer Distinguished Professor.
  • Melinda K. Higgins

    1. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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    • Associate Research Professor and Senior Biostatistician.

  • This publication was supported by a postdoctoral fellowship in Health care Quality and 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). The authors wish to thanks Mr. Steve Ellwood, ABJ, Associate Director of Instructional Technology, Nell Hodgson Woodruff School of Nursing, Emory University, for formatting the figure files. We extend our deepest gratitude to the participants on the study units and the study hospital for helping us discover what nurses do with and for patients during patient turnover events.

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. © 2013 Wiley Periodicals, Inc. Res Nurs Health 36: 554–556, 2013

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