How nurses and physicians judge their own quality of care for deteriorating patients on medical wards: Self-assessment of quality of care is suboptimal

Objective: To describe how nurses and physicians judge their own quality of care for deteriorating patients on medical wards compared with the judgment of independent experts. Design: Cross-sectional study using interviews of care-providers regarding their perceived quality of care for clinically deteriorating patients compared with retrospective judgment by independent experts. Setting: Academic Medical Center of Amsterdam, the Netherlands. Patients: Between April and July 2009, all patients with cardiopulmonary arrests and unplanned intensive care unit admissions from six medical nursing wards were included. The care-providers (nurses and physicians) taking care of these patients in the previous 12 hrs were included. Measurements and Main Results: Forty-seven events and 198 interviews were analyzed. Skill and knowledge level regarding the recognition of a deteriorating patient were rated on a scale of 1-10 with means (SD) of 7.9 (0.8) and 7.7 (0.9), respectively. Nurses and residents attributed coordination of care largely to themselves (74% and 76%, respectively). Communication, cooperation, and coordination were graded in a positive manner (medians between 7.3 and 8), whereas the medical staff graded these factors higher compared to the grading by nurses and residents. Negative predictive values regarding the presence of a delay compared with an expert panel was 37% for nurses and 38% for residents and specialists. Conclusions: Care-providers mostly rate their care provided to patients in the hours preceding a life-threatening adverse event as good. In contrast, independent experts had a more critical appraisal of the provided care in regards to timely recognition. These findings may partly explain the reluctance of care-providers to implement patient safety initiatives. (Crit Care Med 2012; 40: 2982-2986)