Does clinical supervision of health professionals improve patient safety? A systematic review and meta-analysis.
OBJECTIVE
To determine whether clinical supervision (CS) of health professionals improves patient safety.


METHODS
Databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking.


METHODS
Two reviewers independently applied inclusion and exclusion criteria. Thirty-two studies across three health professions [medicine (n = 29), nursing (n = 2) and paramedicine (n = 1)] were selected.


METHODS
The quality of each study was rated using the Medical Education Research Study Quality Instrument. Risk ratios (RR) were calculated for patient safety outcomes of mortality, complications, adverse events, reoperation following initial surgery, conversion to more invasive surgery and readmission to hospital.


RESULTS
Results of meta-analyses provided low-quality evidence that supervision of medical professionals reduced the risk of mortality (RR 0.76, 95% CI 0.60-0.95, I(2) = 76%) and supervision of medical professionals and paramedics reduced the risk of complications (RR 0.69, 95% CI 0.53-0.89, I(2) = 76%). Due to a high level of statistical heterogeneity, sub-group analyses were performed. Sub-group analyses provided moderate-quality evidence that direct supervision of surgery significantly reduced the risk of mortality (RR 0.68, 95% CI 0.50-0.93, I(2) = 33%) and direct supervision of medical professionals conducting non-surgical invasive procedures significantly reduced the risk of complications (RR 0.33, 95% CI 0.24-0.46, I(2) = 0%).


CONCLUSIONS
CS was associated with safer surgery and other invasive procedures for medical practitioners. There was a lack of evidence about the relationship between CS and safer patient care for non-medical health professionals.
Allied Health Clinical Research Office, Eastern Health, La Trobe University, Level 2/5 Arnold Street, Box Hill, Vic 3128, Australia School of Allied Health, La Trobe University, Bundoora, Vic 3086, Australia.
David A
DA
Snowdon
Department of Orthopaedic Surgery, The Northern Hospital, Epping, Vic 3076, Australia.
Raphael
R
Hau
School of Public Health, La Trobe University, Bundoora, Vic 3086, Australia.
Sandra G
SG
Leggat
Allied Health Clinical Research Office, Eastern Health, La Trobe University, Level 2/5 Arnold Street, Box Hill, Vic 3128, Australia School of Allied Health, La Trobe University, Bundoora, Vic 3086, Australia.
Nicholas F
NF
Taylor
D006282:Health Personnel / Q000458:organization & administration*; D061214:Patient Safety / Q000592:standards*; D058996:Quality Improvement
adverse events; clinical supervision; complications; patient safety