Brookfield CR, Phillips PPJ, Shorten RJ. Q fever-the superstition of avoiding the word "quiet" as a coping mechanism: randomised controlled non-inferiority trial.
BMJ 2019;
367:l6446. [PMID:
31852676 PMCID:
PMC7190014 DOI:
10.1136/bmj.l6446]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE
To determine the validity of the superstition that utterance of the word "quiet" in a clinical setting increases workload.
DESIGN
Prospective randomised controlled non-inferiority study.
SETTING
Microbiology department of a large teaching hospital in Lancashire, UK.
PARTICIPANTS
Two members of the medical microbiology team carried out the duty work on any given week day and an on-call team member on any weekend day. 29 days were assigned in which staff were to say "Today will be a quiet day" and 32 days were assigned in which staff were to refrain from saying the word "quiet" in any context.
INTERVENTIONS
Each day was randomly allocated to either saying "Today will be a quiet day" (intervention group) or refraining from saying the word "quiet" (control group) in any context.
MAIN OUTCOME MEASURES
The primary outcome was mean overall workload: a composite of number of clinically related telephone calls, clinically significant results, or validated results processed by the duty medical microbiology team during a 24 hour period referred to collectively as "clinical episodes." A difference of 30 clinical episodes was considered as the margin of non-inferiority. Secondary outcomes included the individual components of the primary outcome.
RESULTS
Workload was measured each day over a 61 day period (1 May to 30 June 2019). A mean 139.0 clinical episodes occurred on control days compared with 144.9 on days when the experimental intervention was uttered, a difference of 5.9 (95% confidence interval-12.9 to 24.7). The upper bound was less than the specified margin of 30, providing evidence for non-inferiority. No evidence of a difference in workload was found between interventions with any of the four components, whether considering unadjusted or adjusted analyses, or looking at the subgroups of week days or weekends.
CONCLUSIONS
The study findings refute the long held superstition that utterance of the word "quiet" impacts on clinical workload, and therefore it should not be avoided. In the era of considerable staff shortages and increased work related stress, doctors should look to other methods to increase resilience and protect their wellbeing and mental health.
TRIAL REGISTRATION
Lancashire Teaching Hospitals NHS Foundation Trust's research department SE-259.
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