Resident management of emergency department patients: is closer attending supervision needed?

To determine the extent of supervision necessary for emergency medicine residents practicing in the emergency department.

ED of a university-affiliated tertiary care facility with an annual census of 32,000 visits.

All ED patients presenting during study hours during a four-month period.

A prospective study was conducted of changes made by emergency medicine attendings in the management of ED patients seen initially by second-year emergency medicine residents. Second-year emergency medicine residents presented all patients seen by them to a specified emergency medicine attending, who also interviewed and examined these patients. Initial patient care was designed by the resident and modified by the emergency medicine attending. Attending modification was recorded by the emergency medicine attending in the study log. Modifications of the residents' proposed care were designated as major (change resulted in an alteration in patient disposition, detection of unsuspected pathology, or marked revision of intended treatment); minor (change resulted in lesser modification of patient management); or no change.

Four hundred eight patient encounters were included in the study. Sixteen patients (4%) had major modifications of their care, 134 (33%) had minor modifications, and 258 (63%) had no change.

Supervision is required for all patients managed by second-year emergency medicine residents, regardless of complaints. This evaluation should include a direct patient interview and examination by the emergency medicine attending and should not be limited to a case discussion or ED record cosignature.