Direct supervision by attendings doesn't reduce medical errors

(HealthDay)—Direct supervision in which attending physicians join work rounds does not reduce the rate of medical errors, according to a study published online June 4 in JAMA Internal Medicine.

Kathleen M. Finn, M.D., from Massachusetts General Hospital in Boston, and colleagues conducted a nine-month randomized trial performed in an inpatient general medical service of a large academic medical center. Using a crossover design, 22 faculty provided increased direct supervision, in which attending physicians joined work rounds on previously admitted patients, or standard supervision, in which attending physicians were available but did not join work rounds. The analysis included 1,259 patients, with 5,772 patient-days.

The researchers observed no significant difference in the medical error rate between standard and increased supervision (107.6 versus 91.1 per 1,000 patient-days; P = 0.21). The mean length of time spent discussing established patients in the two models did not differ significantly in time-motion analysis of 161 work rounds (202 versus 202 minutes; P = 0.99). When an attending physician joined rounds, interns spoke less (64 versus 55 minutes; P = 0.008). When an attending physician was present, interns reported feeling less efficient (P = 0.02) and less autonomous (P = 0.001), while residents reported feeling less autonomous (P < 0.001); when they participated on work rounds, attending physicians rated the quality of care as higher (P = 0.04).

"In designing morning work rounds, residency programs should reconsider their balance of patient safety, learning needs, and resident autonomy," the authors write.

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