[Supervision of junior doctors and allocation of work tasks regarding admissions and further treatment of acute admitted patients]

Abstract

Introduction: It is being debated whether medical staff working at the emergency departments with acute admission services dealing with medical patients have the required professional competence level. It has not previously been documented which doctors see the acute admissions initially at emergency departments, nor how often these patients are debated with an attending doctor.

Material and methods: Questionnaire survey performed January-April 2008, in which medical interns on call at Danish public hospitals completed an online questionnaire. The questions regarded: admissions and follow-up of patients with clinical deterioration at the wards.

Results: A total of 88 interns with an average of 2.8 months of experience were included in the survey. Sixty percent of the interns answered that they initially dealt with acute admissions. During the day, patients with clinical deterioration are the responsibility of the physicians doing their rounds at the ward. During evening and night hours, 80% of interns say that patients with clinical deterioration are their responsibility. Fifty four percent of participants care for medical patients as they initially arrive at the emergency room. The interns consult the attending doctors in 6-10% (median interval) of the cases, there is no significant correlation between the experience of physicians and the frequency with which the intern consults with the attending physicians (p = 0.07). Sixty four percent of the physicians had not received any training in emergency medicine.

Conclusion: Interns with a few months of experience are frequently the first physicians that acute patients see at the Danish internal medicine wards. There is little supervision on how to handle these patients. There is no correlation between the level of experience and the frequency of asking for help from a senior colleague.