Unravelling the conceptualisation of unfinished care among physicians in acute care hospitals: a scoping review.

backgroundUnfinished care-also referred to as care left undone, missed care or implicit rationing-has been widely studied in nursing but remains poorly defined and underexplored in the medical profession. Physicians play a central role in diagnosis, treatment and coordination of care, yet little is known about the extent, determinants and consequences of unfinished care in their daily work.

objectiveTo systematically map and synthesise existing evidence on how unfinished care among physicians in acute care hospitals has been conceptualised, measured and empirically studied. ELIGIBILITY CRITERIA: Original, peer-reviewed studies on physicians working in acute care hospital settings that explicitly addressed unfinished care, care left undone, missed care, suboptimal care or closely related constructs at the microlevel of clinical work. EXCLUSIONS: primary care, allied professions, adherence to guidelines, underuse at the population level, explicit macrolevel rationing, non-original reports, non-English, no full text available. SOURCES OF EVIDENCE: Five bibliographical databases PubMed, EMBASE, Web of Science, SCOPUS and CINAHL were searched in June 2024 to identify relevant studies. CHARTING

methodsTwo reviewers independently screened titles/abstracts and full texts against prespecified criteria defined following the population, concept, context framework, with consensus resolution. Data were charted on study characteristics, terminology/definitions, measurement approach and findings. Methodological quality was appraised by the authors and an external independent expert using the Mixed Methods Appraisal Tool. Qualitative and quantitative findings were charted, then synthesised via a descriptive and thematic analysis.

resultsUsing predefined inclusion and exclusion criteria, 1971 potentially relevant titles and abstracts were identified and subsequently screened. Eight studies met the inclusion criteria, comprising three quantitative, three qualitative, one mixed methods and one quantitative non-randomised study. Only one study explicitly defined and measured 'care left undone', reporting that 78.3% of surveyed physicians had omitted at least one necessary care activity during their most recent shift. The terminology and clarity of concepts varied significantly across the studies (eg, 'shortcuts', 'missed opportunities', 'suboptimal care'). Identified drivers emerged at both organisational (eg, high workload, poor communication) and individual (eg, burnout, fatigue) levels. While two studies connected care left undone to adverse patient outcomes (eg, readmissions) and worse physician well-being, the overall evidence on its prevalence and consequences remains limited. Overall methodological quality of the included studies was moderate, but conceptual and theoretical development remained limited.

conclusionsThis scoping review reveals major conceptual and empirical gaps in the study of unfinished care among physicians. Terminology is inconsistent, theoretical grounding is weak, and validated measurement tools are lacking. Evidence on prevalence, determinants and consequences remains scarce and largely descriptive. To advance the field, future research must establish conceptual clarity, achieve terminological consensus and develop robust, validated instruments to capture how unfinished care manifests within complex clinical systems.