In-house direct supervision by an attending is associated with differences in the care of patients with a blunt splenic injury

Claridge, Jeffrey A.; Carter, Jeffrey W.; McCoy, Andrew M.; Malangoni, Mark A.

doi:10.1016/j.surg.2011.07.078

Cited by 25 publications

(44 citation statements)

References 9 publications

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“…We analyzed 21 non-randomized studies [1,6-25]: one clinical controlled trial and 20 retrospective cohort studies analyzing a total of 16,940 patients with blunt splenic injury (BSI); 12,449 underwent NOM vs . 4,491 OM (Additional file 1: Table S1).…”

Section: Methodsmentioning

confidence: 99%

“…Twenty studies [1,6-14,16-25] reported participants' age: mean value was specified in 17 studies [1,6-10,12,14,16-25], the age range in one study [11] and median age in another study [13]. Crawford et al .…”

Section: Methodsmentioning

confidence: 99%

“…ISS was reported in 19 studies: mean value was reported in 3 studies [8,12,19], median value ± SD in 14 studies [1,6,7,9,10,14,16-18,20,22-25], the range of ISS was reported in 1 study [11], while in another study [13] ISS was defined with values above or below a cut-off of 25. It was possible to extrapolate the ISS value for the patients in the two compared groups (NOM vs .…”

Section: Methodsmentioning

confidence: 99%

“…It was possible to extrapolate the ISS value for the patients in the two compared groups (NOM vs . OM) from only one study [18], while Costa et al [1], Claridge et al [25], Gaarder et al [14] and Harbrecht et al [9] did not differentiate ISS values between NOM or OM. Cochran et al [7] and Tsugawa et al [6] defined ISS for pediatric or adult patients and for older patients, nevertheless without distinguishing between NOM and OM (Additional file 3: Table S3).…”

Section: Methodsmentioning

confidence: 99%

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Is non-operative management safe and effective for all splenic blunt trauma? A systematic review

et al. 2013

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IntroductionThe goal of non-operative management (NOM) for blunt splenic trauma (BST) is to preserve the spleen. The advantages of NOM for minor splenic trauma have been extensively reported, whereas its value for the more severe splenic injuries is still debated. The aim of this systematic review was to evaluate the available published evidence on NOM in patients with splenic trauma and to compare it with the operative management (OM) in terms of mortality, morbidity and duration of hospital stay.MethodsFor this systematic review we followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" statement. A systematic search was performed on PubMed for studies published from January 2000 to December 2011, without language restrictions, which compared NOM vs. OM for splenic trauma injuries and which at least 10 patients with BST.ResultsWe identified 21 non randomized studies: 1 Clinical Controlled Trial and 20 retrospective cohort studies analyzing a total of 16,940 patients with BST. NOM represents the gold standard treatment for minor splenic trauma and is associated with decreased mortality in severe splenic trauma (4.78% vs. 13.5% in NOM and OM, respectively), according to the literature. Of note, in BST treated operatively, concurrent injuries accounted for the higher mortality. In addition, it was not possible to determine post-treatment morbidity in major splenic trauma. The definition of hemodynamic stability varied greatly in the literature depending on the surgeon and the trauma team, representing a further bias. Moreover, data on the remaining analyzed outcomes (hospital stay, number of blood transfusions, abdominal abscesses, overwhelming post-splenectomy infection) were not reported in all included studies or were not comparable, precluding the possibility to perform a meaningful cumulative analysis and comparison.ConclusionsNOM of BST, preserving the spleen, is the treatment of choice for the American Association for the Surgery of Trauma grades I and II. Conclusions are more difficult to outline for higher grades of splenic injury, because of the substantial heterogeneity of expertise among different hospitals, and potentially inappropriate comparison groups.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Is non-operative management safe and effective for all splenic blunt trauma? A systematic review

et al. 2013

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“…One of the challenges in investigating the impact of IH coverage models in actual practice is that different programs use a wide variety of staffing models to achieve "off-hour" attending coverage, which may also explain the conflicting data on the patient effects of IH coverage. 9,11,[21][22][23] Each individual model may place greater emphasis on either supervision or autonomy, and just as increased supervision may not always lead to improved outcomes, 11,23 increased attending physician presence may not always lessen housestaff autonomy. 24 The new ACGME standards establishing the various levels of supervision for housestaff appropriately address the importance of autonomy as an element of the progression toward independent practice.…”

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confidence: 99%

Perceptions of 24/7 In-Hospital Intensivist Coverage on Pediatric Housestaff Education

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Increasing numbers of hospitals are instituting 24/7 in-hospital pediatric intensivist coverage. Data regarding patient outcomes are mixed and the impact on housestaff education remains unknown. WHAT THIS STUDY ADDS:This study quantifies the perceived impact of in-hospital attending coverage on pediatric resident and critical care fellow education and also investigates the growing concern that increasing supervision may contribute to housestaff being less well prepared for independent clinical practice. abstract BACKGROUND: In recent years, the focus on patient safety and housestaff supervision has led to a steady increase in institutions providing 24/7 in-hospital (also known as in-house, henceforth referred to as IH) coverage by pediatric intensivists. Effects of this increased attending physician presence on education of pediatric housestaff have not been studied. We hypothesized that IH coverage would decrease perceived autonomy of housestaff and negatively affect their preparedness to be independent attending physicians on completion of training. METHODS:A secure, anonymous, Web-based survey was sent to pediatric intensivists in the United States and Canada, and pediatric critical care fellows and pediatric residents at academic centers across the United States. Questions focused on perceptions of IH coverage and housestaff educational experience. RESULTS:We report 1323 responses from 147 institutions (center response rate 74%). Although 96% of respondents stated that the PICU provides "a good educational experience," only 50% of pediatric intensivists and 67% of housestaff feel that housestaff are prepared for independent practice after training in an IH model. Compared with those training in home-call models, respondents currently working in IH models have more favorable perceptions of the effects of IH coverage on housestaff autonomy (P , .0001), supervision (P , .0001), and preparation for independent practice (P , .0001).CONCLUSIONS: Pediatric intensivists and housestaff express concern regarding the preparation of housestaff training in a 24/7 IH attending model. An important priority for institutions using or considering a 24/7 IH attending coverage model is the balance between adequate housestaff supervision and autonomy. Dr Rehder conceptualized and designed the study, supervised data collection, completed data analysis, and drafted the initial manuscript; Dr Cheifetz conceptualized and designed the study and critically reviewed the manuscript; Dr Willson assisted with study design and critically reviewed the manuscript; Dr Turner assisted with conceptualization and study design, participated in data analysis, and critically reviewed and revised the manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi/doi/10.1542/peds. 2013-1990 doi:10.1542/peds.2013-1990 Accepted for publication Sep 19, 2013 In academic medical centers, increasing emphasis is being placed on housestaff supervision and attending physician presence. [1][...

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Influence of Resident Involvement on Trauma Care Outcomes

Bukur¹,

Singer²,

Chung³

et al. 2012

Arch Surg

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In-house direct supervision by an attending is associated with differences in the care of patients with a blunt splenic injury

Cited by 25 publications

References 9 publications

Is non-operative management safe and effective for all splenic blunt trauma? A systematic review

Is non-operative management safe and effective for all splenic blunt trauma? A systematic review

Perceptions of 24/7 In-Hospital Intensivist Coverage on Pediatric Housestaff Education

Influence of Resident Involvement on Trauma Care Outcomes

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