When Should a Surgical Resident Call an Attending Surgeon?

Silverman, Adam T.; Goldfarb, Michael A.; Baker, Thomas

doi:10.1016/j.jsurg.2007.11.004

Cited by 14 publications

(5 citation statements)

References 15 publications

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“…In Section 3, I present a model in which both the instrumental and the image motive drive consulting behavior. The model explains why protocols that dictate consulting behavior do not always work (Roberts et al, 2008;Silverman et al, 2008). Broadly, the predictions of my model are consistent with the existing evidence on consulting behavior in other workplaces.…”

Section: Introductionsupporting

confidence: 81%

Why are junior doctors reluctant to consult attending physicians?

Swank

2010

Journal of Health Economics

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Section: Introductionsupporting

confidence: 81%

Why are junior doctors reluctant to consult attending physicians?

Swank

2010

Journal of Health Economics

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“…While there is little published literature examining escalation of care, several studies comment on the importance of clinical uncertainty, overnight supervision of junior medical staff and communication. Silverman et al examined judgement amongst surgical residents and surgical attendings in New Jersey, USA, with regards to when an attending should be contacted about a patient's care 9 . A significant difference was found between the two groups and, consequently, the investigators created a list of conditions with recommendations for residents to either call the attending surgeon or leave a message (for non-urgent matters) in order to standardise communication 9 .…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Factors Influencing Escalation of Care by Junior Medical Officers

Rotella

Ferguson

et al. 2014

Anaesth Intensive Care

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Patients can acutely deteriorate unexpectedly. Junior medical officers (JMOs) are often first to review patients who become unwell. Opportunities to escalate care to a senior colleague may exist prior to the need for a rapid response team review. Little is known about the factors that influence JMO decisions to escalate care. In this study, our objective was to investigate the self-reported factors that influence escalation of care by JMOs in a university-affiliated, tertiary level hospital. We designed a face-to-face questionnaire of JMOs using standardised introduction to minimise interviewer bias. Fifty JMOs participated in the study (a 100% response rate). Most (63.3%) felt that they would be able to identify a clinically deteriorating patient. They would be more likely to escalate care if they were not familiar with the patient's clinical problem. If handover plans were seen to be adequate, JMOs felt it was less necessary to escalate care. Few JMOs (12%) agreed that they limited escalation due to fear of criticism or fear of conflict with senior medical staff. Although 36% agreed that they were concerned about waking seniors overnight, only 6% feared that escalating care overnight would affect their future career prospects. Escalation of care appears to be mostly influenced by the confidence and familiarity of the JMO with the cause of deterioration. JMOs identified clear handover with documented goals of treatment and suggested actions in event of clinical deterioration as the best means by which to improve the process of escalation of care for clinically deteriorating patients.

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“…The pervasiveness of simulation training in surgical residency means that trainees are spending increased time working on their non-technical skills, one of the most critical of which is communication (ie, information transfer). 53 The QUIT tool can be used to assess the efficacy of communication skills training, which is important as residents and nurses are using time away from the wards and direct patient care to participate in training. Although the QUIT tool is not intended to be a rigid protocol, the categories and items within it can also be used to teach residents and nurses to standardize and structure information transfer during escalation of care, thus acting as a training tool as well as a tool for evaluation.…”

Section: Discussionmentioning

confidence: 99%