Table 4

Examples of nurse–physician responses rated as no agreement

Aspect of carePhysician serviceNurse responsePhysician responseClinical scenario
DiagnosisHospitalist serviceChest painMelaena, syncopeThe patient was admitted with syncope related to upper gastrointestinal haemorrhage
DiagnosisTeaching serviceMental status changesDyspnoeaThe patient, who had a history of dementia, presented with new dyspnoea
TestsTeaching serviceNo tests plannedComputed tomographic scan of chestThe patient, who had a history of a heart transplant, was admitted with cough and fever. A chest x-ray was unremarkable
TestsHospitalist serviceStress testNo tests plannedThe patient was admitted with unstable angina. A myocardial perfusion imaging study had been ordered but was cancelled in the morning according to a cardiologist's recommendation that the patient undergo a cardiac catheterisation
ProceduresTeaching serviceNo procedures plannedArthrocentesis and irrigation of the kneeThe patient was admitted with fever and swollen, tender left knee. The orthopaedic surgery team had performed a bedside arthrocentesis and lavage that morning. No “time out” was documented in the medical record
ProceduresTeaching serviceColonoscopyNo procedures plannedThe patient presented with cough, fever and haematemesis. The patient remained stable and an upper endoscopy was planned to be completed after discharge
Medication changesHospitalist serviceNo medication changes plannedInsulin aspart and glargine doses increasedThe patient, who had a history of diabetes mellitus, was admitted with a chronic obstructive pulmonary disease exacerbation. Glucose was elevated because of acute illness and treatment with glucocorticoid
Medication changesTeaching serviceNo medication changes plannedFurosemide discontinuedThe patient, who had a history of heart failure, was admitted with cellulitis and found to be in acute renal failure
ConsultationsHospitalist serviceGastroenterologyNo consultations plannedThe patient, who had a history of a chronic abdominal pain of unclear aetiology, was admitted for abdominal pain. The patient had recently completed an extensive diagnostic workup
ConsultationsTeaching serviceNo consultations plannedPalliative care, nephrologyThe patient, who had a history of metastatic bladder cancer, was admitted with hyponatremia