American Academy of Emergency Medicine

Attending Supervision of Nonemergency Medicine Residents in a University Hospital ED

Holliman CJ, Wuerz RC, Kimak MJ, Burkhart KK, Donovan JW, Rudnick HL, Bates MA, Muller HA.

Am J Emerg Med. 1995;13:259-261.

This study demonstrated that attending emergency medicine faculty physicians frequently make major changes in non-EM residents' patient care plans. Among 1,000 study patients, the attending made major changes in the non-emergency medicine residents plan of care 153 times (15%) including 17 changes felt to be life or limb saving. It is clear that a number of potentially life and limb-threatening errors were made by the residents and prevented by the attending supervision. These results confirm the importance of attending supervision of all patients in the ED.

One interpretation of the data is that ED "moonlighting" by unsupervised non-EM residents is not safe. The study also supports the concept that EM faculty should supervise the care for every case in the department and not just selected cases. The residents in the study apparently could not distinguish those cases that could be handled safely by themselves.

Supervision by qualified EM attendings of non-EM residents in an ED directly improved patient care. Additionally, non-EM residents required major changes at a rate about four times higher than that of EM residents reported from a prior study. The need for attending supervision appears to be even more important for non-EM house staff than for EM house staff.