Mortality rates under the care of junior and senior surgery residents in a surgical intensive care unit/neurologic intensive care unit: A 5-year retrospective cohort study at Taoyuan Armed Forces General Hospital

Lee, Ming‐Tsung; Hu, Philip; Hsi, Sheng-Chuan; Liu, Kuang-Yi; Chao, Hong-Ming; Chen, Yue-Quen

doi:10.1016/j.jcrc.2008.03.039

Cited by 8 publications

(3 citation statements)

References 20 publications

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“…Six studies showed that more senior residents had better patient outcomes or higher patient satisfaction scores compared with junior residents [42-44,46,47,50]. One study showed that morbidity and mortality were not adversely affected by residents working under different levels of supervision [45].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the effects of residency training on patient outcomes

Leeuw

Lombarts

Arah

et al. 2012

BMC Med

144

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BackgroundResidents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.MethodsThe literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.ResultsNinety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design. Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.ConclusionsThe majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.

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Section: Resultsmentioning

confidence: 99%

A systematic review of the effects of residency training on patient outcomes

Leeuw

Lombarts

Arah

et al. 2012

BMC Med

144

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“…One of the studies of overnight intensivist presence mentioned in the introduction (a multicentre retrospective cohort study of 65,752 patients) found the presence of overnight ICUspecific medical staff (ICU trainees or consultants) was beneficial for patient mortality compared to no dedicated overnight ICU medical staff, but the presence of an intensivist within a team that included ICU trainees was not beneficial 3 . While they did not examine the seniority or experience levels of ICU junior medical staff, earlier studies have found an inverse association between ICU trainee experience and patient mortality 9,10 , while a distinction between senior ICU trainees and ICU consultants is less apparent 11 . Taken together, this suggests that an increase to overnight ICU medical staffing is beneficial only if the existing medical team is insufficient in experience level or number, implying a possible 'threshold' effect.…”

Section: Discussionmentioning

confidence: 93%

Impact of Increasing Overnight Intensive Care Unit Registrar Staffing on Duration of Intubation of Elective Cardiac Surgery Patients

Durie

Darvall

Rechnitzer

et al. 2015

Anaesth Intensive Care

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It is unclear whether increases to overnight junior medical staffing levels can improve ICU patient outcomes. We conducted a retrospective cohort study before and after the introduction of a third overnight ICU registrar at a 24-bed metropolitan ICU in February 2012. We hypothesised that this change would be associated with decreased intubation time for elective cardiac surgery patients and an increase in the proportion of these patients being extubated during the overnight period. All elective cardiac surgery patients were included from two temporally matched six-month periods (May to October) in 2011 and 2012. The primary outcome was median duration of intubation, and the secondary outcome was proportion of patients extubated during the 'overnight' period (2200 to 0700). A total of 142 and 188 patients were included in the control and intervention cohorts, respectively. Median (IQR) intubation time was 8.7 (6.6 to 14.5) hours in the control cohort and 8.2 (6.0 to 13.4) hours in the intervention cohort, with no significant difference between groups (P=0.40). The proportion of elective cardiac surgery patients extubated during the overnight period was similar, 54.2% in the control group compared to 50.0% in intervention group (P=0.45). In our unit, increasing overnight ICU registrar staffing levels was not associated with a significant reduction in duration of intubation for elective cardiac surgery patients or a reduction in the proportion of these patients extubated overnight. This is likely due to factors other than medical staffing levels influencing timing of extubation of these patients.

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“…To study the overall impact of quality Parameters of hospital services Scott, Malvehy, James, & Pines, 2010;Crago, 2010;Bajpai & Sangeeta, 2004;Bruce & Barton, 2004;de Vos, M., et al, 2007;Lee, et al, 2008).…”

Section: Objectives Of Hce Quality Parameters/dimensions As Component...mentioning

confidence: 99%

AHP Model for Identifying Best Health Care Establishment

Azam

Qureshi

Talib

2015

International Journal of Productivity Management and Assessment Technologies

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The purpose of this study is to develop an analytic hierarchy process (AHP) model utilizing components, parameters, and factors of a specifically designed Integrated Quality Model for Health Care Establishment (HCE). In doing so, the authors have utilized AHP approach to identify the best health care service quality performer among alternatives of HCEs. To select the best HCE, three HCEs of North India namely: HCE-A; HCE-B; and HCE-C were chosen. The criteria components of the integrated quality model for the HCE designed and suggested by and were adopted. Further, this study has undertaken an extensive in-depth literature review about AHP and its applications for HCEs from various aspects. A specifically developed integrated quality model for HCE with its components parameters, factors thereof, duly coded as criteria and sub-criteria have been utilized. It thus, facilitates the development of an AHP model to rank the chosen HCEs helping to identify potentially the best HCE among them. On the basis of the proposed hierarchical model, the findings suggest that the HCE-A may be selected first followed by HCE-C and HCE-B based on overall rating. The study provides a mechanism through AHP model to select potentially best HCE utilizing specifically developed integrated quality model for HCE with impacts both for the clients and the patients to enjoy the service of best HCE as well as for the managers to improve the services of HCE and the business. The study thus, adds a new perspective by developing a selection process to select the best HCE through an AHP model utilizing criteria and sub-criteria of an integrated quality model specifically developed for HCE. It has practical value for maintaining service quality of HCE to benefit the clients and related stakeholders as well as the managers by improving quality, enhancing reputation and business thereof.

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Mortality rates under the care of junior and senior surgery residents in a surgical intensive care unit/neurologic intensive care unit: A 5-year retrospective cohort study at Taoyuan Armed Forces General Hospital

Cited by 8 publications

References 20 publications

A systematic review of the effects of residency training on patient outcomes

A systematic review of the effects of residency training on patient outcomes

Impact of Increasing Overnight Intensive Care Unit Registrar Staffing on Duration of Intubation of Elective Cardiac Surgery Patients

AHP Model for Identifying Best Health Care Establishment

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