Deepak Palakshappa1, Lindsay P Carter2, Chadi M El Saleeby3. 1. Pediatric Medical Services, Harvard Medical School, Boston, MA. Electronic address: PalakshappaD@email.chop.edu. 2. Pediatric Medical Services, Harvard Medical School, Boston, MA; Division of Pediatric Hospital Medicine, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA. 3. Pediatric Medical Services, Harvard Medical School, Boston, MA; Division of Pediatric Hospital Medicine, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA; Division of Pediatric Infectious Diseases, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA.
Abstract
OBJECTIVE: To examine differences in expectations when a resident should contact a supervising physician in several hospital-based, after-hours clinical circumstances. STUDY DESIGN: We developed 34 scenarios collectively considered the most common or serious issues encountered by on-call residents, and incorporated them into a survey of pediatric residents, fellows, and attendings. For each scenario, participants were asked whether the resident should talk to the attending/fellow immediately or delay communication until the next day. ORs comparing attendings/fellows and residents were calculated, and subgroup analyses were performed examining differences among the study populations. RESULTS: A total of 112 participants completed the survey (91% response rate). In 17 of the 34 scenarios (50%), more attendings/fellows than residents asked for immediate communication (OR >1; P < .05). Most discrepant scenarios were in uncertain areas in which residents may feel comfortable managing the issue without supervisory input or, alternatively, fail to recognize an evolving matter or a deteriorating clinical status. In subgroup analyses, residents were homogeneous in their responses; however, responses of fellows and junior faculty differed from those of senior faculty in 7 of the 34 scenarios, with senior attendings more likely desiring immediate communication. CONCLUSION: We found differences in expectations of when a pediatric resident should contact a supervising physician after hours not only between residents and attendings/fellows, but among attendings themselves. These differences could lead to medical errors, miscommunication, and inconsistent supervision for overnight residents.
OBJECTIVE: To examine differences in expectations when a resident should contact a supervising physician in several hospital-based, after-hours clinical circumstances. STUDY DESIGN: We developed 34 scenarios collectively considered the most common or serious issues encountered by on-call residents, and incorporated them into a survey of pediatric residents, fellows, and attendings. For each scenario, participants were asked whether the resident should talk to the attending/fellow immediately or delay communication until the next day. ORs comparing attendings/fellows and residents were calculated, and subgroup analyses were performed examining differences among the study populations. RESULTS: A total of 112 participants completed the survey (91% response rate). In 17 of the 34 scenarios (50%), more attendings/fellows than residents asked for immediate communication (OR >1; P < .05). Most discrepant scenarios were in uncertain areas in which residents may feel comfortable managing the issue without supervisory input or, alternatively, fail to recognize an evolving matter or a deteriorating clinical status. In subgroup analyses, residents were homogeneous in their responses; however, responses of fellows and junior faculty differed from those of senior faculty in 7 of the 34 scenarios, with senior attendings more likely desiring immediate communication. CONCLUSION: We found differences in expectations of when a pediatric resident should contact a supervising physician after hours not only between residents and attendings/fellows, but among attendings themselves. These differences could lead to medical errors, miscommunication, and inconsistent supervision for overnight residents.
Authors: Jillian S Catalanotti; Alec B O'Connor; Michael Kisielewski; Davoren A Chick; Kathlyn E Fletcher Journal: J Gen Intern Med Date: 2021-01-28 Impact factor: 6.473