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ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH

Resident Training Level and Quality of Anesthesia Care in a University Hospital

Karen L. Posner, PhD^*,, and Peter R. Freund, MD^*,

*Departments of Anesthesiology and Anthropology, University of Washington; and Anesthesia Clinical Services, University of Washington Medical Center, Seattle

Address correspondence to Karen L. Posner, PhD, Department of Anesthesiology, Box 356540, University of Washington, Seattle, WA 98195-6540. Address e-mail to posner{at}u.washington.edu

In this study, we analyzed the relationship between resident training and patient safety in anesthesia. A retrospective quality improvement database review was used to calculate the relative risk of any quality problem and specific types of quality problems (injury, escalation of care, or operational inefficiency) between anesthesia teams with CA1, CA2, and CA3 residents. It was expected that teams with less experienced residents (CA1) would have more frequent quality problems than teams with more experienced residents (CA2 and CA3 teams). Data showed that risk of injury did not differ between CA1, CA2, and CA3 teams. CA2 teams had higher rates of critical incidents and escalation of care than CA1 and CA3 teams and higher rates of operational inefficiency than CA3 teams. The CA2 yr is when residents move into specialty training, requiring more advanced skills and a larger knowledge base. Their higher relative risk for critical incidents, escalation of care, and operational inefficiencies may reflect lack of experience, uncertainty, and less skill mastery compared with CA3 residents. The higher inefficiency and escalation of care rates associated with CA2 teams may translate into larger costs for the institution.

IMPLICATIONS: Appropriate supervision of anesthesia residents helps to ensure patient safety. Anesthesia management problems are most common during the CA2 yr and result in higher costs for the institution.

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