The findings are published in the April 7 issue of the New England Journal of Medicine.
Previous studies have demonstrated that poor supervision and a heavy workload lead to increased fatigue-related errors and reduced participation in educational activities. “This association has prompted a call to examine the supervision and education of junior doctors caring for hospitalized patients,” said lead study author Graham McMahon, MD, MMSc, of the Department of Medicine at BWH.
The researchers compared traditional care teams with redesigned care teams that treated approximately 4,000 inpatients over a 12 month period. Hospital staff and trainees provided suggestions on how to create an optimal team structure to care for inpatients. Two of these redesigned teams, known as the integrated teaching unit (ITU), comprised of two teaching attending physicians, two second- or third-year residents and three first-year medical interns working with an integrated team of nurses and other care professionals. The two traditional care teams were comprised of one teaching attend physician, one resident, and two interns.
The patient group admitted to the ITU had a lower in-hospital mortality and decreased length of stay compared to the group admitted to a traditional team. Though patient satisfaction scores were comparatively high for both teams, satisfaction was higher for attendings, residents, and interns in the ITUs compared to those on traditional teams. Interns in the ITUs were also able to spend more time studying, learning, and teaching than traditional-team interns.
“These results finally demonstrate that investing in the training and supervision of junior doctors does not only improve the quality of patient care, but also increases hospital efficiency: it’s a win-win” explains Dr. McMahon.
The study was funded by the Department of Medicine at BWH.