The Effect of Intensive Inpatient Attending Supervision on Medical Errors, Patient Safety and Resident Education
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 134
- 主要终点
- Measurement of the rate of medical errors defined as preventable adverse events and near misses. Patient Safety Outcome
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Other
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- 未提供
排除标准
- 未提供
研究组 & 干预措施
Intervention Arm
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.
干预措施: Enhanged Attending Supervision (Other)
Control Arm
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.
干预措施: Standard of Care (Other)
结局指标
主要结局
Measurement of the rate of medical errors defined as preventable adverse events and near misses. Patient Safety Outcome
时间窗: 9 months
Using a previously validated protocol (PMID:24871238) to assess these outcomes, five research nurses reviewed the medical records, formal incident reports from the hospital incident-reporting system, daily pharmacy reports, pharmacy paging logs and solicited reports from nurses working on the study units and noted any adverse events or near misses. Four physician investigators, blinded to attending and intervention, classified each suspected incident as an adverse event, near miss or exclusion (an incident determined to be neither a medical error or adverse event). Physician reviewers further classified all adverse events as preventable or non-preventable. Medical Error rates are reports as number of events per 1,000 patient days
Resident Engagement on Rounds: Educational Outcome
时间窗: 9 months
Time motion study of the amount of time residents and faculty speak during rounds. Time was measured by a research assistant using a Microsoft access program embedded on an IPAD that recorded length of time. Time measurement outcomes are reported in minutes
次要结局
- Resident and Faculty Perception of Education, Educational Outcome(9 months)
- Deaths, Patient Safety Outcome(9 months)
- Transfers to the Intensive Care Unit, Patient Safety Outcome(9 months)
研究者
Kathleen Finn
Inpatient Associate Program Director
Massachusetts General Hospital