The Effect of Intensive Inpatient Attending Supervision on Medical Errors, Patient Safety and Resident Education

Mass General Brigham

Status: Completed

Conditions: Focus of Study is on Graduate Medical Education Supervision

Treatments: Other: Enhanged Attending Supervision; Other: Standard of Care

Study type: Interventional

Funder types: Other

Identifiers

NCT03318198

2015D005158

Details and patient eligibility

About

Randomized cross over trial investigating the effect of intensive attending supervision of residents caring for inpatients on the medical service on both patient safety and educational outcomes. Hypothesis: increased attending supervision would improve patient safety and resident education.

Full description

Background While the relationship between resident work hours and patient safety has been extensively studied, little research has evaluated the role of attending supervision on patient safety and education.

Investigators conducted a 9-month randomized, cross-over trial on an inpatient medicine teaching service where 22 faculty provided either: 1) direct supervision where attendings joined work rounds on established (previously admitted) patients or 2) standard supervision where attendings were available, but did not join work rounds. Each faculty member participated in both arms in random order. The primary safety outcome was rate of medical errors. Secondary safety outcomes included deaths and transfers to the intensive care unit. Resident education was evaluated via a time motion study to assess resident participation on rounds and surveys to measure resident and attending educational ratings.

Enrollment: 134 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria

• Teaching attending on the medicine service at Massachusetts General Hospital
• Resident physician on the medical service at Massachusetts General Hospital

Exclusion Criteria

• Faculty unable to complete both control and intervention arms of the study.
• Faculty unwilling to participate
• Residents unwilling to participate

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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134 participants in 2 patient groups, including a placebo group

Intervention Arm

Active Comparator group

Description:

Attendings on the interventional arm attended daily work rounds with the resident teams in addition to established work rounds on the previously admitted patients on the care team.

Treatment:

Other: Enhanged Attending Supervision

Control Arm

Placebo Comparator group

Description:

Attendings crossed over to the control arm in which they did not attend work rounds with the team and only say new admissions with the resident team. This was usual care.

Treatment:

Other: Standard of Care