Impact of 'the Q word' on hospital speciality activity levels: a narrative systematic review.

Abstract

BACKGROUND: Healthcare professionals commonly believe that saying the word 'quiet' can jinx a shift and lead to increased workload or particularly unwell patients. A previous small integrative review found no effect but had some methodological limitations. This narrative systematic review aimed to synthesise the evidence from studies on the impact of saying 'quiet' on clinical workload measures. METHODS: A comprehensive search was carried out across multiple electronic databases for any studies performed in a human healthcare setting investigating the impact of the use of 'the Q word' (or variations thereof) on workload. Outcomes of interest were objective measures of workload, such as patient volume, admissions or tasks. RESULTS: Eight randomised controlled trials (RCTs) were included. Settings included EDs, specialised hospital units and clinical support services. Outcome measures varied between studies, so meta-analysis was not possible. Seven RCTs found no significant differences in objective workload measures between intervention groups where 'q****" was uttered and control groups where it was not. One RCT in orthopaedics reported an increase in overnight admissions when 'q****" was said but had significant methodological limitations. Two RCTs noted potential impacts on subjective perceptions of workload among believers. Limitations of included studies include small sample sizes, lack of blinding and inadequate control for confounders. DISCUSSION: The available evidence does not support the assertion that saying the word 'quiet' affects clinical workload metrics. Healthcare professionals should be encouraged to prioritise communication based on evidence rather than myth, and there is insufficient evidence that saying 'quiet' while on shift will bring negative consequences for themselves or colleagues.