CHARMED RCT – Doctor to Doctor Case Presentation and Errors

June 22, 2018

Written by Clay Smith

Spoon Feed
Simply presenting patients to another physician reduced serious adverse events (NNT = 24) and near-misses.  Now we just need to overcome our resistance and ask our colleagues for advice and input.

Why does this matter?
During residency, we presented every case to the attending.  This led to discussion and often a change in management.  But once we get into practice, case presentation to another physician ceases.  But might it still be a good idea?

Check yourself before you wreck yourself
This was a cluster RCT of physicians in France who presented their patients’ cases to the other physician on duty three times a day compared with those who did not.  Overall, 840 cross-check patients and 840 standard care patients were enrolled.  In the cross-check group, 54/840 patients (6.4%) had adverse events, as opposed to 90/840 (10.7%) in the standard care group, NNT =24 . There was also a reduction in near-misses.  We all understand how important this is for residency training, but this was among attending physicians.  What it tells me is that when I have a tough case, discussing it with a colleague can reduce my chance of making an error in management.  It takes a lot of courage and humility to ask for help and advice, but doing so may lead to a CHARMED existence in the ED.

Source
Effect of Systematic Physician Cross-checking on Reducing Adverse Events in the Emergency Department: The CHARMED Cluster Randomized Trial.  JAMA Intern Med. 2018 Apr 23. doi: 10.1001/jamainternmed.2018.0607. [Epub ahead of print]

Reviewed by Thomas Davis