Steven E. North, Esq.
Thirty-three percent of critical patient events were not communicated by residents to attending surgeons according to research conducted in multiple surgery departments and reported in the Annals of Surgery in 2009.
Maybe residents are overconfident or, just the opposite, do not want to appear incompetent or weak. Perhaps they lack the experience to recognize a patient's distress. Maybe their superiors give off signals that deter them. Regardless of the cause, communications breakdowns between residents and the attending physicians who supervise them are common contributors to patient injury and can give rise to claims of medical malpractice.
Surveys completed at 297 institutions between September 2012 and March 2015 by the Accreditation Council for Graduate Medical Education (ACGME) revealed that residents and fellows at each had personally experienced or witnessed inadequate supervision. The organization now mandates that residency programs issue guidelines that define situations that require communication with supervising faculty members.
Four Harvard Medical School-affiliated hospitals have been providing residents with pocket cards listing 15 situations in which prompt notification to or approval from a senior colleague is required. According to Dr. Atul Gawande, the surgeon and author who led the initial research in the Harvard program, chiefs of surgery at the four hospitals must make it clear to incoming residents that it's okay to call a supervisor even when they think it is dumb. The chiefs are also asked to tell their senior attending physicians, These are the things we are telling residents they have to call you for, and we really expect you are going to take the call and not bite anybody's head off. The program is working.
A study covering the Harvard program from August 2007 to March 2009 and published in the Annals of Surgery in 2011, found that the proportion of critical events that were not conveyed to an attending decreased from 33 percent to 2 percent.
That's better for patient outcomes, better for residents, better for hospital ratings, and better for attending physicians who, though possibly spending more time in supervision, could end up avoiding time in court.
Source: The Wall Street Journal, August 9, 2016
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