Effect of the 2011 vs 2003 Duty Hour Regulation–Compliant Models on Sleep Duration, Trainee Education, and Continuity of Patient Care Among Internal Medicine House Staff

Desai, Sanjay V.; Feldman, Leonard; Brown, Lynette M.; Dezube, Rebecca; Yeh, Hsin Chieh; Punjabi, Naresh M.; Afshar, K.; Grunwald, Michael R.; Harrington, Colleen; Naik, Rakhi P.; Cofrancesco, Joseph

doi:10.1001/jamainternmed.2013.2973

Cited by 215 publications

(222 citation statements)

References 26 publications

Supporting

Mentioning

217

Contrasting

Order By: Relevance

“…4,5 In this era of duty hour restrictions, there has been concern that residents experience increased workload due to having fewer hours to do the same amount of work. 6,7 As such, the Accreditation Council of Graduate Medical Education emphasizes the quality of those hours, with a focus on several aspects of the resident working environment as key to improved educational and patient safety outcomes. [8][9][10] Geographic localization of physicians to patient care units has been proposed as a means to improve communication and agreement on plans of care, 11,12 and also to reduce resident workload by decreasing inefficiencies attributable to traveling throughout the hospital.…”

Section: Resultsmentioning

confidence: 99%

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

2013

View full text Add to dashboard Cite

BACKGROUND Geographic localization of physicians to patient care units may improve communication, decrease interruptions, and reduce resident workload. This study examines whether interns on geographically localized patient care units receive fewer pages than those on teams that are not. METHODS The study is a retrospective analysis of the number of pages received by interns on 5 internal medicine teams: 2 in a geographically localized model (GLM), 2 in a partial localization model (PLM), and 1 in a standard model (SM) over 1 month at New York–Presbyterian Hospital/Weill Cornell. Multivariate linear regression techniques were used to analyze the relationship between the number of pages received per intern and the type of team. RESULTS The number of pages received per intern per hour, adjusted for team census and number of admissions, was 2.2 (95% confidence interval [CI]: 2.0–2.4) in the GLM, 2.8 (95% CI: 2.6–3.0) in the PLM, and 3.9 (95% CI: 3.6–4.2) in the SM; all differences were statistically significant (P < 0.001). CONCLUSION Geographic localization of resident teams to patient care units was associated with significantly fewer pages received by interns during the day. Such patient care models may improve resident workload in part by decreasing pages, and consequently has important implications for patient safety and medical education. Journal of Hospital Medicine 2014;9:120–122. © 2013 Society of Hospital Medicine

show abstract

Section: Resultsmentioning

confidence: 99%

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

2013

View full text Add to dashboard Cite

show abstract

“…1 Communication failures are known to be a major cause of adverse events, and handoffs are particularly vulnerable periods for these events to occur. 2,3 IM trainees have recognized that discontinuity in handoffs can lead to uncertainty regarding patient care and an increased risk of medical errors.…”

Section: Introductionmentioning

confidence: 99%

Predicting and Communicating Risk of Clinical Deterioration: An Observational Cohort Study of Internal Medicine Residents

et al. 2014

View full text Add to dashboard Cite

BACKGROUND: Despite its importance, little is known about internal medicine (IM) residents' ability to assess and communicate a patient's overnight risk during the resident-to-resident handoff. OBJECTIVE: To evaluate IM residents' ability to identify patients at risk for clinical deterioration using the Patient Acuity Rating (PAR) tool (scored on a 1-7 symmetric scale; 1="Extremely unlikely", 7="Extremely likely"), and to measure how well IM residents conveyed a patient's potential for clinical deterioration during day-to-night handoff. DESIGN AND PARTICIPANTS: Observational cohort study of 46 postgraduate year 1 (PGY-1) and 32 postgraduate year 3 (PGY-3) internal medicine residents rotating on one of four general medicine services from October 2013 through January 2014. MAIN MEASURES: Primary outcomes were (1) level of agreement between resident handoff giver and receiver regarding patients' clinical risk and (2) accuracy of resident-assigned PAR score in predicting a patient's risk of clinical deterioration over the subsequent 24 hours. KEY RESULTS: Analysis of PGY-1 giver-receiver handoff agreement revealed an intraclass correlation coefficient (ICC) (95 % CI) of 0.51 (0.45-0.56), while PGY-3 giverreceiver agreement yielded an ICC (95 % CI) of 0.42 (0.36-0.47). Based on 865 ratings of 378 patients, PGY-1 handoff giver PAR scores of 5 and 6+ were significantly associated with increased odds of clinical deterioration within 24 hours (aOR=6.5 and 12.4; P=0.03 and 0.005, respectively). For the 1,170 PAR ratings of 438 patients assigned by PGY-3 handoff givers, PAR scores of 4, 5, and 6+ were significantly associated with increased odds of an event within 24 hours (aORs=6.0, 9.6, and 18.1; P=0.03, 0.01, and 0.0008, respectively). CONCLUSIONS: The PAR is a useful tool to quantify IM residents' judgment of patient stability, and may be particularly valuable during resident handoff, given that the level of agreement between giver and receiver regarding patient risk is only fair.

show abstract

“…Internal medicine residents in a prospective crossover design study of less frequent night call versus a novel night float system experienced more sleep but fewer educational opportunities and more handovers under either modified system. 10 By contrast, replacement of a traditional call schedule model with a night float system across several studies improved duty hour compliance, reduced fatigue, and improved neuropsychological performance, although it did reduce operative experience for residents in some specialties.…”

Section: Discussionmentioning

confidence: 99%

An ACGME Duty Hour Compliant 3-Person Night Float System for Neurological Surgery Residency Programs

Ragel¹,

Piedra²,

Klimo³

et al. 2014

Journal of Graduate Medical Education

View full text Add to dashboard Cite

Background In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted the 24+6-hour work schedule and 80-hour workweek, and in 2011, it enhanced work hour and supervision standards. Innovation In response, Oregon Health & Science University's (OHSU) neurological surgery residency instituted a 3-person night float system. Methods We analyzed work hour records and operative experience for 1 year before and after night float implementation in a model that shortened a combined introductory research and basic clinical neurosciences rotation from 12 to 6 months. We analyzed residents' perception of the system using a confidential survey. The ACGME 2011 work hour standards were applied to both time periods. Results After night float implementation, the number of duty hour violations was reduced: 28-hour shift (11 versus 235), 8 hours off between shifts (2 versus 20), 80 hours per week (0 versus 17), and total violations (23 versus 275). Violations increased only for the less than 4 days off per 4-week interval rule (10 versus 3). No meaningful difference was seen in the number of operative cases performed per year at any postgraduate year (PGY) training level: PGY-2 (336 versus 351), PGY-3 (394 versus 354), PGY-4 (803 versus 802), PGY-5 (1075 versus 1040), PGY-7 (947 versus 913), and total (3555 versus 3460). Residents rated the new system favorably. Conclusions To meet 2011 ACGME duty hour standards, the OHSU neurological surgery residency instituted a 3-person night float system. A nearly complete elimination of work hour violations did not affect overall resident operative experience.

show abstract

Effect of the 2011 vs 2003 Duty Hour Regulation–Compliant Models on Sleep Duration, Trainee Education, and Continuity of Patient Care Among Internal Medicine House Staff

Cited by 215 publications

References 26 publications

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

Predicting and Communicating Risk of Clinical Deterioration: An Observational Cohort Study of Internal Medicine Residents

An ACGME Duty Hour Compliant 3-Person Night Float System for Neurological Surgery Residency Programs

Contact Info

Product

Resources

About