Supervision, Not Regulation of Hours, Is the Key to Improving the Quality of Patient Care

Abstract

Department, Pittsburgh, Pa, in which S.K. and her mother were treated. We also express our thanks to Ellen Wald, MD, for her critical reading of the manuscript, and the Children's Hospital of Pittsburgh Cardiothoracic Trans¬ plant Team for their analytical discussion of the issues.1. Kantrowitz A, Haller JD, Joos H, Cerruti MM, Carstensen HE. Transplantation of the heart in an infant and an adult. Am J Cardiol. 1968;22:782-790.

Clinical Oversight: Conceptualizing the Relationship Between Supervision and Safety

“…2,3 In both the United States and Canada, resident work-hours restrictions have significantly decreased the amount of time that trainees spend in relatively autonomous on-call work. [4][5][6] Internationally, the increasing awareness of medical error, [7][8][9] along with a small body of literature associating increased clinical supervision with better patient outcomes, [10][11][12] has led to calls for increased intensity of clinical supervision in the name of quality of care and patient safety from such varied sources as government committees, 13,14 medicolegal review boards, 15,16 and the popular press. 17 These influences on clinical supervision practices have led to widespread increases in the supervision of clinical trainees.…”

Duty Hour Reform and Internal Medicine Residency Training: No Time to Lose

“…Even the death of Libby Zion, which ultimately heralded resident duty hour restrictions in New York 20 years ago, was attributed to a multitude of factors, such as inadequate supervision, workload, and fatigue. 10 …”

Impact of a Resident Strike on Emergency Department Quality Indicators at an Urban Teaching Hospital

“…It required every resident to be supervised by a physician who has completed residency in order to improve the quality of patient care. [1][2][3] In 1989, the American College of Physicians produced similar guidelines. 4 The supervision of residents in emergency medicine (EM) has been debated, centering on mandating 24-hour coverage by attending physicians.…”