'More hands on deck, more often' may not improve quality of care, study suggests

Researchers from the Penn State Hershey Medical Center in Hershey, Pa.., have reported that the implementation of on-site overnight supervision from attending-level physicians, has had no significant impact on clinical outcomes. 

The study, published in the Journal of General Internal Medicine, was the first to look at the impact of overnight academic hospitalist programs, which have been implemented by many hospitals in response to concerns for patient safety and quality of care.

The researchers, led by Jed Gonzalo, MD, associate dean for health systems education at Penn State College of Medicine in Hershey, evaluated the effect of one such program established in September 2012. In order to compare outcomes from before and after, they analyzed patient records starting in April 2001 through May 2014 — 42 percent of patients were admitted before the OAH program began, and 58 percent were admitted after.

The in-hospital mortality rate decreased from 1.1 percent prior to the intervention to 0.9 percent following the implementation of the program. The 0.2 percent difference is not considered statistically significant.

"Given that regulatory bodies are pushing toward on-site house staff supervision, the medical education community needs to think about how to continue to allow autonomy for residents," Dr. Gonzalo said in statement. "For years, residents were on their own at night — they had to make decisions on their feet, because the buck stopped with them. Newer models of care at night have the potential to strip away residency autonomy because they can lean on the attending now. However, the other view is 'the more eyes, the better.' So it's a challenge we need to think more about to balance education and ideal patient outcomes."

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