Written by Clay Smith
There was no patient safety benefit to having attending internal medicine physicians physically join rounds on established (not new) inpatients. My application of this to the ED is to make sure I give our residents enough autonomy to learn.
Why does this matter?
Patient safety is of paramount importance and reduction of errors is a key way to optimize safety. Does having an experienced attending physician present during work rounds reduce errors?
Attention helicopter attendings – give residents some space
This was a randomized crossover design with highly-rated internal medicine attending physicians either physically rounding with the team on established inpatients (not new patients) or being available to “run the list” of established patients with the team but not physically present on rounds. Blinded research nurses reviewed charts and found no difference in medical errors or near-misses if an attending was present (though there was a non-significant trend toward error reduction). Rounding time was the same whether the attending was present or not, which surprised me. Interns spoke up less, felt less efficient, and less autonomous when the attending was present. Attending physicians rated the quality of care as better when they were present. This is not directly applicable the ED, as everyone is a new patient. My take-home is to avoid being a helicopter attending, micromanaging every little thing, and give residents enough space to manage patients on their own.
Effect of Increased Inpatient Attending Physician Supervision on Medical Errors, Patient Safety, and Resident Education: A Randomized Clinical Trial. JAMA Intern Med. 2018 Jun 4. doi: 10.1001/jamainternmed.2018.1244. [Epub ahead of print]
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Reviewed by Thomas Davis