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 durin g holidays is not regulated by regional laws; some facilities employ staff physicians, others employ physicians engaged from year to year (temporary p hysicians), and others employ publicly funded National Health System (NHS) physicians. This study was designed to determine whether the use of differe nt kinds of physicians leads to different outcomes with regard to the rate of hospitalization and appropriateness of the management of adverse clinica l events. DESIGN: Prospective, nonrandomized-survey data collection. SETTING: Ten nonprofit nursing facilities in Italy. PARTICIPANTS: Three hundred and fifty-two NH residents, staff physicians, t emporary physicians, and NHS physicians. MEASUREMENTS: Medical intervention during adverse clinical events occurring at night and during holidays. RESULTS: Three hundred and fifty-two residents experienced 551 adverse clin ical events; 78 were hospitalized. The hospitalization rate of NHS physicia ns was about two times that of the temporary physicians and six times that of the staff physicians. Staff physicians' diagnoses and management were ap propriate in the majority of cases; NHS diagnosis and management were doubt ful or incorrect in about one-third of all cases. CONCLUSIONS: NH residents frequently experience adverse clinical events; ph ysician characteristics influence the rate of hospitalization and the quali ty of medical interventions.