title: The impact of in-house attending surgeon supervision on the rates of preventable and potentially preventable complications and death at the start of the new academic year.
abstract: The purpose of this study was to examine the impact of in-house attending surgeon supervision on the rate of preventable deaths (PD) and complications (PC) at the beginning of the academic year. All trauma patients admitted to the Los Angeles County + University of Southern California Medical Center over an 8-year period ending in December 2009 were reviewed. Morbidity and mortality reports were used to extract all PD/PC. Patients admitted in the first 2 months (July/August) of the academic year were compared with those admitted at the end of the year (May/June) for two distinct time periods: 2002 to 2006 (before in-house attending surgeon supervision) and 2007 to 2009 (after 24-hour/day in-house attending surgeon supervision). During 2002 to 2006, patients admitted at the beginning of the year had significantly higher rates of PC (1.1% for July/August vs 0.6% for May/June; adjusted odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1 to 3.2; P < 0.001). There was no significant difference in mortality (6.5% for July/August vs 4.6% for May/June; adjusted OR, 1.1; 95% CI,0.8 to 1.5; P = 0.179). During 2007 to 2009, after institution of 24-hour/day in-house attending surgeon supervision of fellows and housestaff, there was no significant difference in the rates of PC (0.7% for July/August vs 0.6% for May/June; OR, 1.1; 95% CI, 0.8 to 1.3; P = 0.870) or PD (4.6% for July/August vs 3.7% for May/June; OR, 1.3; 95% CI, 0.9 to 1.7; P = 0.250) seen at the beginning of the academic year. At an academic Level I trauma center, the institution of 24-hour/day in-house attending surgeon supervision significantly reduced the spike of preventable complications previously seen at the beginning of the academic year.
authors.affiliation: Division of Trauma and Surgical Critical Care, University of Southern California Medical Center, Los Angeles, California, USA.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Adam
authors.initials: A
authors.lastname: Hauch
authors.forename: Bernardino C
authors.initials: BC
authors.lastname: Branco
authors.forename: Stephen
authors.initials: S
authors.lastname: Cohn
authors.forename: Pedro G R
authors.initials: PG
authors.lastname: Teixeira
authors.forename: Gustavo
authors.initials: G
authors.lastname: Recinos
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology / Q000517:prevention & control*; D007396:Internship and Residency / Q000458:organization & administration; D008297:Male; D019300:Medical Errors / Q000401:mortality / Q000517:prevention & control* / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D008875:Middle Aged; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D055815:Young Adult