Rate of undesirable events at beginning of academic year: retrospective cohort study Export

@article{citeulike:5946002, abstract = {Objective To determine whether an increase in the rate of undesirable events occurs after care provided by trainees at the beginning of the academic year. Design Retrospective cohort study using administrative and patient record data. Setting University affiliated hospital in Melbourne, Australia. Participants 19 560 patients having an anaesthetic procedure carried out by first to fifth year trainees starting work for the first time at the hospital over a period of five years (1995-2000). Main outcome measures Absolute event rates, absolute rate reduction, and rate ratios of undesirable events. Results The rate of undesirable events was higher at the beginning of the academic year compared with the rest of the year (absolute event rate 137 v 107 per 1000 patient hours, relative rate reduction 28\%, P<0.001). The overall adjusted rate ratio for undesirable events was 1.40, 95\% confidence interval 1.24 to 1.58. This excess risk was seen for all residents, regardless of their level of seniority. The excess risk decreased progressively after the first month, and the trend disappeared fully after the fourth month of the year (rate ratio for fourth month 1.21, 0.93 to 1.57). The most important decreases were for central and peripheral nerve injuries (relative difference 82\%), inadequate oxygenation of the patient (66\%), vomiting/aspiration in theatre (53\%), and technical failures of tracheal tube placement (49\%). Conclusions The rate of undesirable events was greater among trainees at the beginning of the academic year regardless of their level of clinical experience. This suggests that several additional factors, such as knowledge of the working environment, teamwork, and communication, may contribute to the increase. 10.1136/bmj.b3974}, author = {Haller, Guy and Myles, Paul S. and Taffe, Patrick and Perneger, Thomas V. and Wu, Christopher L.}, citeulike-article-id = {5946002}, citeulike-linkout-0 = {http://dx.doi.org/10.1136/bmj.b3974}, citeulike-linkout-1 = {http://bmj.com/content/339/oct13_1/b3974.abstract}, citeulike-linkout-2 = {http://bmj.com/content/339/oct13_1/b3974.full.pdf}, day = {13}, doi = {10.1136/bmj.b3974}, journal = {BMJ}, keywords = {anaesthesia, education, safety}, month = {October}, number = {oct13\_1}, pages = {b3974+}, posted-at = {2009-10-16 05:31:16}, priority = {4}, title = {Rate of undesirable events at beginning of academic year: retrospective cohort study}, url = {http://dx.doi.org/10.1136/bmj.b3974}, volume = {339}, year = {2009} }

TY - JOUR ID - citeulike:5946002 L3 - citeulike-article-id:5946002 N2 - Objective To determine whether an increase in the rate of undesirable events occurs after care provided by trainees at the beginning of the academic year. Design Retrospective cohort study using administrative and patient record data. Setting University affiliated hospital in Melbourne, Australia. Participants 19 560 patients having an anaesthetic procedure carried out by first to fifth year trainees starting work for the first time at the hospital over a period of five years (1995-2000). Main outcome measures Absolute event rates, absolute rate reduction, and rate ratios of undesirable events. Results The rate of undesirable events was higher at the beginning of the academic year compared with the rest of the year (absolute event rate 137 v 107 per 1000 patient hours, relative rate reduction 28%, P<0.001). The overall adjusted rate ratio for undesirable events was 1.40, 95% confidence interval 1.24 to 1.58. This excess risk was seen for all residents, regardless of their level of seniority. The excess risk decreased progressively after the first month, and the trend disappeared fully after the fourth month of the year (rate ratio for fourth month 1.21, 0.93 to 1.57). The most important decreases were for central and peripheral nerve injuries (relative difference 82%), inadequate oxygenation of the patient (66%), vomiting/aspiration in theatre (53%), and technical failures of tracheal tube placement (49%). Conclusions The rate of undesirable events was greater among trainees at the beginning of the academic year regardless of their level of clinical experience. This suggests that several additional factors, such as knowledge of the working environment, teamwork, and communication, may contribute to the increase. 10.1136/bmj.b3974 IS - oct13_1 JF - BMJ TI - Rate of undesirable events at beginning of academic year: retrospective cohort study VL - 339 SP - b3974 KW - anaesthesia KW - education KW - safety AU - Haller, Guy AU - Myles, Paul AU - Taffe, Patrick AU - Perneger, Thomas AU - Wu, Christopher PY - 2009/10/13/ UR - http://dx.doi.org/10.1136/bmj.b3974 ER -