Hospitalized Patients' Perceptions of Resident Fatigue, Duty Hours, and Continuity of Care

Drolet, Brian C.; Hyman, Charles H.; Ghaderi, Kimeya F.; Rodriguez-Srednicki, Joshua; Thompson, Jordan M.; Fischer, Staci A.

doi:10.4300/jgme-d-14-00128.1

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…Our patient results demonstrate that patients cared for by extended duty-hour interns do not note significant differences in their overall satisfaction, the amount they saw their medical team, how well the doctors knew their medical problems, or how well the doctors listened to them. Although prior literature has suggested that patients have greater concerns about fatigue and working hours than about continuity of care, 11 our data show no indication that the patients perceived differences between the 2 groups. However, in our study, patients were not informed of the differences in intern duty hours between the 2 units.…”

Section: Discussioncontrasting

confidence: 99%

“…However, these studies also noted that attitudes differed significantly between interns and program directors about the impact of shift length. [8][9][10] Although survey data have suggested that patients express greater concern about fatigue and working hours than about continuity of care, 11 little research has evaluated the effect of intern work hours on the patient experience as well as the perceptions of the other members of the interdisciplinary care team, such as nurses.…”

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confidence: 99%

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Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes

Salgado

Katz²,

Pelletier³

et al. 2022

J Patient Saf

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ObjectiveIn 2017, interns were permitted to work continuously for up to 28 hours at a time, a reversal from the previously mandated 16-hour limit. Our objective was to evaluate perceptions of care and patient outcomes on an extended (28-hour) compared with a limited (16-hour) duty-hour system on identical interdisciplinary teams.MethodsSixty-two interns, 27 residents, 28 attendings, and 449 patients participated. Patients completed surveys assessing their satisfaction. Anonymous weekly surveys were obtained from interns, residents, and attendings evaluating perceptions of intern tiredness, overall satisfaction, and performance. Nursing surveys evaluated intern and medical team performance. Objective outcome measures, including intensive care unit transfers, length of stay, readmissions, mortality, and complications, were assessed through a retrospective, blinded chart review.ResultsPatients reported similar satisfaction in care. Extended duty-hour interns reported significantly decreased familiarity with their patients, decreased ability to conduct physical exams on new patients, increased tiredness, and decreased overall satisfaction. Residents overseeing extended-duty interns reported significantly decreased quality in intern presentations and overall quality of teaching, and increased perception of intern tiredness and increased incorrect orders. Attending physicians reported significantly improved quality of new patient presentations by extended duty-hour interns. No significant differences in patient objective outcome measures were noted.ConclusionsExtended intern duty hours do not affect patient’s satisfaction with their care. Although interns in the extended duty-hour system reported significantly increased fatigue and decreased overall satisfaction and residents’ perceived increases in incorrect intern orders in the extended duty-hour system, there were no detrimental effects on patient safety.

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Section: Discussioncontrasting

confidence: 99%

mentioning

confidence: 99%

Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes

Salgado

Katz²,

Pelletier³

et al. 2022

J Patient Saf

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“…[8][9][10][11] Long duty-hours have been linked to several resident, patient, and community safety concerns [12][13][14][15] . Likewise, patients do not appear to feel comfortable with physicians who worked long hours 5,6 . With these concerns, we argue that iCOMPARE should have demonstrated superiority of unrestricted shift lengths.…”

mentioning

confidence: 99%

“…Patients are both interested in, and concerned by, the length of their doctors' shifts 5 . Indeed, in one study, a significant number of patients stated they would like to be informed of any clinician who had worked over 12 hours 6 . Patients and residents deserve to be informed of factors affecting their care, particularly in a trial with the primary endpoint involving their 30-day mortality.…”

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confidence: 99%

iCOMPARE, what value does it add to resident duty-hour discussions?

Hopkins

Secrest

2019

F1000Res

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Discussions regarding resident duty-hour restrictions have been ongoing and heated. One influential argument for restrictions has been patient safety. Two trials, FIRST and iCOMPARE, were performed to investigate this relationship with surgical and medicine training, respectively. As the authors are approaching this discussion from a medicine-based perspective, iCOMPARE will serve as the primary basis of our discussion. Results from the iCOMPARE trial comparing flexible (28-hour shifts allowed) to the original 2011 ACGME shift requirements (maximum 16 hours) were recently published in the New England Journal of Medicine. This non-inferiority trial used 30-day post-hospitalization mortality as its primary endpoint. Results met qualifications for non-inferiority, and ACGME policy was changed to allow for 28-hour shifts for medicine residents. iCOMPARE results were highly lauded and used as primary justification for extending resident duty hours. Despite this sweeping impact, few have critically evaluated what this study actually adds to the literature. Herein, we argue that serious questions regarding trial design are apparent. Most importantly, the non-inferiority margins chosen were large, and represent an ambiguous marker of resident performance. Additionally, we question the lack of both patient consenting and direct patient-reported or patient-centered outcomes within the hospital stay. As more discussion arises in the medical literature surrounding patient-reported outcomes and shared decision making, we argue that the results of iCOMPARE disregarded the patient perspective or meaningful patient outcomes in an attempt to maintain status quo. Lastly, we discuss how iCOMPARE missed the broader question of actual duty-hour restrictions, and some practical methods already in practice at some programs, which may more directly balance resident work hours with patient care and resident learning.

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Who’s My Doctor? Team-Based Management

Leiphart¹,

Ecklund²

2018

Controversies in Severe Traumatic Brain Injury Management

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Hospitalized Patients' Perceptions of Resident Fatigue, Duty Hours, and Continuity of Care

Abstract: In a survey about physician attributes relevant to medical errors and patient safety, adult inpatients in a large and diverse sample reported greater concern about fatigue and working hours than about continuity of care.

Cited by 5 publications

References 23 publications

Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes

Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes

iCOMPARE, what value does it add to resident duty-hour discussions?

Who’s My Doctor? Team-Based Management

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