title: Outcomes of the patients in the respiratory care center are not associated with the seniority of the caring resident.
abstract: Although many studies show that the experience level of physicians is significantly associated with the outcomes of their patients, little evidence exists to show whether junior residents provide worse care than senior residents. This study was conducted to analyze whether the experience level of residents may affect the outcomes of patients cared for in a well-organized setting. We conducted a 7-year retrospective study utilizing statistical data from a respiratory care center (RCC) in a medical center between October 2004 and September 2011. In addition to the two medical residents who had been trained in the intensive care unit (ICU), the RCC team also included attending physicians in charge, a nurse practitioner, a case manager, a dietitian, a pharmacist, a social worker, registered respiratory therapists, and nursing staff. Weaning from mechanical ventilation was done according to an established weaning protocol. The 84 months analyzed were classified into five groups according to the levels of the two residents working in the RCC: R2 + R1, R2 + R2, R3 + R1, R3 + R2, and R3 + R3. The monthly weaning rate and mortality rate were the major outcomes, while the mean ventilator days, rate of return to the ICU, and nosocomial infection incidence rate were the minor outcomes. The groups did not differ significantly in the monthly weaning rate, mortality rate, mean ventilator days, rate of return to the ICU, or nosocomial infection incidence rate (p > 0.1). Further analysis showed no significant difference in the monthly weaning rate and mortality rate between months with a first-year resident (R1) and those with two senior residents (p > 0.2). Although the weaning rate in the RCC gradually improved over time (p < 0.001), there was no significant difference in the monthly weaning rate between the groups after adjusting for time and disease severity (p > 0.7). Thus, we concluded that in a well-organized setting, the levels (experiences) of residents did not significantly affect patient outcomes. This result may be attributed to the well-developed weaning protocol and teamwork processes in place, which avoid a large effect from any single factor and provide stable and high-quality care to the patients.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Tsai
authors.forename: Ju-Yin
authors.initials: JY
authors.lastname: Huang
authors.forename: Po-Ju
authors.initials: PJ
authors.lastname: Wei
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Wang
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Yang
authors.forename: Tung-Heng
authors.initials: TH
authors.lastname: Wang
authors.forename: Jhi-Jhu
authors.initials: JJ
authors.lastname: Hwang
mesh_terms: D003428:Cross Infection / Q000150:complications / Q000401:mortality* / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency / Q000458:organization & administration / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012121:Respiration, Artificial; D012138:Respiratory Therapy; D012140:Respiratory Tract Diseases / Q000150:complications / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D015300:Ventilator Weaning