Analyzing supply and demand on a general internal medicine ward: a cross-sectional study

Fralick, Michael; Kaw, Neal; Wang, Mingkun; Mamdani, Muhammad; Mourad, Ophyr

doi:10.9778/cmajo.20200252

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…Additionally, the available data did not capture other outcomes related to learner and patient experience that are likely affected by maintaining continuity of care during changeover. 54 Furthermore, we did not explore the outcomes of attending physician changeover in isolation.…”

Section: Limitationsmentioning

confidence: 99%

Analysis of Resident and Attending Physician End-of-Rotation Changeover Days and Association With Patient Length of Stay

et al. 2023

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ImportanceEnd-of-rotation resident physician changeover is a key part of postgraduate training but could lead to discontinuity in patient care.ObjectiveTo test whether patients exposed to end-of-rotation resident changeover have longer hospital stays and whether this association is mitigated by separating resident and attending changeover days.Design, Setting, and ParticipantsThis retrospective cohort analysis included adult patients admitted to general internal medicine. The changeover day was the same day (first Monday of month) for both resident and attending physicians until June 30, 2013 (preseparation period), and then intentionally staggered by 1 or more days after July 1, 2013 (postseparation period). This was a multicenter analysis at 4 teaching hospitals in Ontario, Canada, from July 1, 2010, to June 30, 2019. Data analysis was conducted from July 2022 to January 2023.ExposuresPatients were classified as changeover patients if the first Monday was a resident changeover day and as control patients if the first Monday was not a resident changeover day.Main Outcomes and MeasuresThe primary outcome was length of hospital stay. Secondary outcomes were transfer to critical care, in-hospital death, and rate of discharge per 100 patients on the index day.ResultsOf 95 282 patients. 22 773 (24%; mean [SD] age, 67.8 [18.8] years; 11 156 [49%] female patients) were exposed to resident changeover, and 72 509 (76%; mean [SD] age, 67.8 [18.7] years; 35 293 [49%] female patients) were not exposed to resident changeover. Exposure to resident changeover day was associated with a slightly longer hospital stay compared with control days (0.20 [95% CI, 0.09-0.30] days; P &lt; .001) and decreased relative risk of patient discharge on the index day (relative risk, 0.92; 95% CI, 0.86-1.00; P = .047). These associations were similar in the preseparation and postseparation periods. Resident changeover was not associated with an increased risk of transfer to critical care or in-hospital death.Conclusions and RelevanceIn this study, a small positive association between exposure to resident physician changeover and length of hospital stay as well as reduced rate of discharge was found. These findings suggest that separating changeover days for resident and attending physicians may not significantly change these associations.

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Section: Limitationsmentioning

confidence: 99%

Analysis of Resident and Attending Physician End-of-Rotation Changeover Days and Association With Patient Length of Stay

et al. 2023

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“…Clinical on‐call duties are vital to residency training 1,2 . In contrast, gaps in clinical care from unplanned on‐call absences are stressful for residents and training programmes 3 . Resident absences are often unpredictable and attributable to diverse factors including personal illness, acute injuries, family emergencies, sudden hardships or practical logistics (e.g.…”

Section: Introductionmentioning

confidence: 99%

On‐call absences and academic recognition: A retrospective cohort analysis

2023

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BackgroundResident call schedules require careful planning and are vulnerable to unanticipated absences from unpredictable factors. We tested whether unplanned absences from resident call schedules were associated with the likelihood of subsequent academic recognition.MethodsWe examined unplanned absences from call shifts for internal medicine residents at the University of Toronto from 2014 to 2022 (8 years). We identified institutional awards granted at the end of the academic year as an indicator of academic recognition. We defined the resident‐year as the unit‐of‐analysis that started in July and ended in June of the subsequent year. Secondary analyses examined the association between unplanned absences and the likelihood of academic recognition in later years.ResultsWe identified 1668 resident‐years of training in internal medicine. In total, 579 (35%) had an unplanned absence, and the remaining 1089 (65%) had no unplanned absence. Baseline characteristics were similar between the two groups of residents. In total, 301 awards were received for academic recognition. The likelihood of receiving an award at the end of the year was 31% lower for residents who had any unplanned absence compared with those who had no absence (adjusted odds ratio = 0.69, 95% confidence interval 0.51–0.93, p = 0.015). The likelihood of receiving an award was further decreased for residents with multiple unplanned absences compared with those with none (odds ratio 0.54, 95% confidence interval 0.33–0.83, p = 0.008). An absence during the first year of residency was not significantly associated with the likelihood of academic recognition in later years of training (odds ratio 0.62, 95% confidence interval 0.36–1.04, p = 0.081).ConclusionsThe results of this analysis suggest unplanned absences from scheduled call shifts may be associated with a decreased likelihood of academic recognition for internal medicine residents. This association could reflect countless confounders or the prevailing culture of medicine.

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Analyzing supply and demand on a general internal medicine ward: a cross-sectional study

Cited by 2 publications

References 8 publications

Analysis of Resident and Attending Physician End-of-Rotation Changeover Days and Association With Patient Length of Stay

Analysis of Resident and Attending Physician End-of-Rotation Changeover Days and Association With Patient Length of Stay

On‐call absences and academic recognition: A retrospective cohort analysis

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