The Effect of Intensive Inpatient Attending Supervision on Medical Errors, Patient Safety and Resident Education
2017年10月18日 更新者：Kathleen Finn、Massachusetts General Hospital
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.
研究概览
地位
完全的
详细说明
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.
研究类型
介入性
注册 (实际的)
134
阶段
- 不适用
参与标准
研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
18年 及以上 (成人、年长者)
接受健康志愿者
不
有资格学习的性别
全部
描述
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
学习计划
本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。
研究是如何设计的？
设计细节
- 主要用途：其他
- 分配：随机化
- 介入模型：交叉作业
- 屏蔽：无（打开标签）
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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有源比较器：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.
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Attendings were randomized at the start of the study to begin in the enhanced supervision arm where they attended resident work rounds.
They then crossed over to the control arm where they did not attend work rounds.
The outcomes were assessed between the two periods during which the attending participated in the study; attending work rounds vs. not attending work rounds.
|
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安慰剂比较：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.
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Attendings participated directly in new patient rounds but did not see patients previously known to the team with the residents.
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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Measurement of the rate of medical errors defined as preventable adverse events and near misses. Patient Safety Outcome
大体时间：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
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9 months
|
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Resident Engagement on Rounds: Educational Outcome
大体时间：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
|
9 months
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Resident and Faculty Perception of Education, Educational Outcome
大体时间：9 months
|
A 20 question survey based on prior literature (PMID: 25340363) asking about resident and faculty experience with different levels of faculty supervision.
The survey questions each were followed by a 5 point scale with a range from strongly agree, agree, neutral, disagree to strongly disagree.
Strongly agree represents a better outcome.
There were no subscales.
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9 months
|
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Deaths, Patient Safety Outcome
大体时间：9 months
|
Hospital collected data on the number of medical patients who died during the study
|
9 months
|
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Transfers to the Intensive Care Unit, Patient Safety Outcome
大体时间：9 months
|
Hospital collected data on the number of medical patients who were transferred to the intensive care unit
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9 months
|
合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
调查人员
- 首席研究员：Kathleen Finn, MD、Massachusetts General Hospital
出版物和有用的链接
负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。
一般刊物
- 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.
- 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.
- 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.
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始 (实际的)
2015年9月1日
初级完成 (实际的)
2016年6月1日
研究完成 (实际的)
2017年4月1日
研究注册日期
首次提交
2017年10月16日
首先提交符合 QC 标准的
2017年10月18日
首次发布 (实际的)
2017年10月23日
研究记录更新
最后更新发布 (实际的)
2017年10月23日
上次提交的符合 QC 标准的更新
2017年10月18日
最后验证
2017年10月1日
更多信息
与本研究相关的术语
其他研究编号
- 2015D005158
计划个人参与者数据 (IPD)
计划共享个人参与者数据 (IPD)？
不
IPD 计划说明
The data and results from the study are listed to the research personnel associated with the study.
药物和器械信息、研究文件
研究美国 FDA 监管的药品
不
研究美国 FDA 监管的设备产品
不
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