Clinical trial NCT03318198: The Effect of Intensive Inpatient Attending Supervision on Medical Errors, Patient Safety and Resident Education
Official title: The Effect of Intensive Inpatient Attending Supervision on Medical Errors, Patient Safety and Resident Education
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Focus of Study is on Graduate Medical Education Supervision
Keywords: Graduate Medical Education
Attending Supervision of Residents
Patient Safety
Lead sponsor: Massachusetts General Hospital
Sponsor class: OTHER
First posted: 2017-10-23
Enrollment: 134
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: We 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. Resident education was evaluated via a time motion study to assess resident participation on rounds and surveys to measure resident and attending educational ratings.
Primary purpose: OTHER

Brief summary: 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.

Detailed 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.

Eligibility 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

Primary outcomes:
measure: Measurement of the rate of medical errors defined as preventable adverse events and near misses. Patient Safety Outcome
timeFrame: 9 months
measure: Resident Engagement on Rounds: Educational Outcome
timeFrame: 9 months
Secondary outcomes:
measure: Resident and Faculty Perception of Education, Educational Outcome
timeFrame: 9 months
measure: Deaths, Patient Safety Outcome
timeFrame: 9 months
measure: Transfers to the Intensive Care Unit, Patient Safety Outcome
timeFrame: 9 months
Other outcomes:
Locations:
Study officials:
affiliation: Massachusetts General Hospital
name: Kathleen Finn, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Biondi EA, Varade WS, Garfunkel LC, Lynn JF, Craig MS, Cellini MM, Shone LP, Harris JP, Baldwin CD. Discordance between resident and faculty perceptions of resident autonomy: can self-determination theory help interpret differences and guide strategies for bridging the divide? Acad Med. 2015 Apr;90(4):462-71. doi: 10.1097/ACM.0000000000000522.
citation: Starmer AJ, O'Toole JK, Rosenbluth G, Calaman S, Balmer D, West DC, Bale JF Jr, Yu CE, Noble EL, Tse LL, Srivastava R, Landrigan CP, Sectish TC, Spector ND; I-PASS Study Education Executive Committee. Development, implementation, and dissemination of the I-PASS handoff curriculum: A multisite educational intervention to improve patient handoffs. Acad Med. 2014 Jun;89(6):876-84. doi: 10.1097/ACM.0000000000000264.
citation: Finn KM, Metlay JP, Chang Y, Nagarur A, Yang S, Landrigan CP, Iyasere C. Effect of Increased Inpatient Attending Physician Supervision on Medical Errors, Patient Safety, and Resident Education: A Randomized Clinical Trial. JAMA Intern Med. 2018 Jul 1;178(7):952-959. doi: 10.1001/jamainternmed.2018.1244.