Entrustable Professional Activities (EPAs) have highlighted entrustment of autonomy by attending physicians to housestaff as a measure of assessment in graduate medical education. Entrustment is a key concept in understanding housestaff readiness to progress through training into unsupervised, though it is unknown how it may affect patient outcomes. This study aims to explore the association between attending entrustment of autonomy to housestaff and patient outcomes, specifically 30‐day hospital readmission or emergency department (ED) visits for patients on a general medicine inpatient team.
From 2001‐2009, data was collected on inpatients on the University of Chicago general medicine service through the Hospitalist Project, a study that uses inpatient interviews, administrative records, chart review and a postdischarge telephone survey to assess the care of hospitalized patients. Attending physicians are also surveyed. The primary outcome of interest, 30‐day readmission or ED visit, was obtained from patient self‐report in the follow‐up interview. Entrustment of autonomy was obtained from 2 attending survey items: “My resident felt that s/he had sufficient autonomy this month” and “The interns were truly involved in decision‐making about their patients”, and defined as a response of “Strongly Agree” to either statement. Multivariate conditional logistic regression was used to explore associations between readmission and entrustment of autonomy.
Of the 15,590 patients enrolled, 9,524 were included in the analysis (61.1%). Response rate for attendings was 67% (734 /1103). 34.7% of patients reported a 30‐day readmission or ED visit. Autonomy was entrusted to 50.2% of residents and 43.9% of interns. Multivariate analysis demonstrated no significant association between odds of readmission and entrustment of autonomy. However, when stratifying on resident experience, there was a differential effect of entrustment. When the team resident was more senior (postgraduate year [PGY] 3+), odds of readmission were 21% lower with entrustment of autonomy (OR=0.79, 95% CI [0.65‐0.96], p=0.018). There was no difference in odds of readmissions with entrustment for patients on teams with junior (PGY2) residents.
There is an association between attending perception of autonomy and decision‐making and 30‐day hospital readmission or ED visit, but only for patients cared for by teams with a senior (PGY3+) team resident. Entrusting autonomy to PGY2 team residents did not appear to affect a patient’s odds of readmission. Entrustment of autonomy may be more thoughtfully prescribed for more senior residents. Attendings may also be more likely to entrust the most capable senior residents who also have better patient outcomes. To our knowledge this is the first time a study has assessed any association between entrustment of autonomy and patient outcomes.
To cite this abstract:Martin S, Farnan J, Flores A, Kurina L, Meltzer D, Arora V. Can I Entrust You? The Association of Entrustment of Autonomy to Housestaff with 30‐Day Readmission. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 20. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/can-i-entrust-you-the-association-of-entrustment-of-autonomy-to-housestaff-with-30day-readmission/. Accessed July 17, 2019.