Implications of transitioning to a resident night float system in neurosurgery: mortality, length of stay, and resident experience

Abstract

OBJECTIVE Many neurosurgical training programs have moved from a 24-hour resident call system to a night float system, but the impact on outcomes is unclear. Here, the authors compare length of stay (LOS) for neurosurgical patients admitted before and after initiation of a night float system at a tertiary care training hospital. METHODS The neurosurgical residency at the University of Alabama at Birmingham transitioned from 24-hour call to a night float resident coverage system in July 2013. In this cohort study, all patients admitted to the neurosurgical service for 1 year before and 1 year after this transition were compared with respect to hospital and ICU LOSs, adjusted for potential confounders. RESULTS A total of 4619 patients were included. In the initial bivariate analysis, night float was associated with increased ICU LOS (p = 0.032) and no change in overall LOS (p = 0.65). However, coincident with the transition to a night float system was an increased frequency of resident service transitions, which were highly associated with hospital LOS (p < 0.01) and ICU LOS (p < 0.01). After adjusting for resident service transitions, initiation of the night float system was associated with decreased hospital LOS (p = 0.047) and no change in ICU LOS (p = 0.35). CONCLUSIONS This study suggests that a dedicated night float resident may improve night-to-night continuity of care and decrease hospital LOS, but caution must be exercised when initiation of night float results in increased resident service transitions.

Nationwide survey comparing residents’ perceptions of overnight duty systems in Singapore: night float versus full overnight call

“…A study has shown that consistency of care could improve cooperation among team members and translate to better continuity of patient care and better patient-doctor rapport. (10) Connelly et al similarly reported that medical students perceived an enhanced level of teamwork after a week of NF. (11) One traditional method of measuring level of training is to look at the number of hours of clinical work performed, with the common assumption that longer work hours translate into proficiency.…”

Does work time limit for resident physician affect short-term treatment outcome and hospital length of stay in patients with spontaneous intracerebral hemorrhage?: a two-year experience at a single training hospital in South Korea

“…In the US and EU wherein the WTL was implemented for resident physician much earlier than that in South Korea, enforcement of the WTL was primarily intended to reduce the resident's sleep deficiency, to improve their clinical performance, and thereby reduce medical error and enhance patient safety. 9) Even if the national environments, policies, and cultural backgrounds in the field of medicine in South Korea have been developed quite different from those in the US and EU, the K-MHW and Korean Hospital Association (KHA) have led the resident physician's WTL analogous to that of the US or EU, that restricted resident work hour to a maximum of 80 hours per week and 36 hours per service shift since March 1, 2018 in response to the revised Labor Standard Act.…”

“…The first case for enforcing the WTL for resident physician was based on a New York City grand jury making a decision that 18 years old Libby Zion's death in 1984 came partially from the resident fatigue. 9) Then, in the US, the first WTL for resident physician was enacted in New York in 1989 because of concerning the patient safety. 27) In 1999, the US Institute of Medicine (IOM) claimed preventable medical errors referring that about 44,000 to 98,000 Americans die in a single year due to avoidable medical adverse events.…”

The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management

“…From an attending perspective, in contradistinction, having the same daytime staff present during the week was associated with a greater degree of continuity of care. [ 30 ]…”