Scheduling in the context of resident duty hour reform

Abstract

Fuelled by concerns about resident health and patient safety, there is a general trend in many jurisdictions toward limiting the maximum duration of consecutive work to between 14 and 16 hours. The goal of this article is to assist institutions and residency programs to make a smooth transition from the previous 24- to 36-hour call system to this new model. We will first give an overview of the main types of coverage systems and their relative merits when considering various aspects of patient care and resident pedagogy. We will then suggest a practical step-by-step approach to designing, implementing, and monitoring a scheduling system centred on clinical and educational needs in the context of resident duty hour reform. The importance of understanding the impetus for change and of assessing the need for overall workflow restructuring will be explored throughout this process. Finally, as a practical example, we will describe a large, university-based teaching hospital network’s transition from a traditional call-based system to a novel schedule that incorporates the new 16-hour duty limit.

Use of a Night Float System to Comply With Resident Duty Hours Restrictions

“…However, studying a system that had more than 2.5 years to mature has a distinct advantage, as implementation of any new system is typically followed by an initial period of perceived negative impact. 59 Further, the NF system is one scheduling model out of many, 35 and there are particularities related to the NF system and to its implementation at our institution that may limit transferability. We provided a detailed description of our local context to facilitate assessment of the transferability of our findings.…”

“…A detailed description of this NF system has been published previously. 35 Seeking maximal phenomenal variation, 40 we purposively sampled-equally across all three training hospitals-nine CTU staff physicians (SMDs) who had experience with the 12-hour NF system; all three hospital-specific residency program directors (PDs), who were involved in the transition from the prior 24-hour call system to the NF system; nine early cohort residents (ERs) who had experience working on the CTUs under both the 24-hour call and the NF systems; and nine late cohort residents (LRs) who had never worked on the CTUs under the previous 24-hour call system as residents (although they may have worked under that system as medical students).…”

“…8 Shift-based NF systems have frequently been used to comply with duty hours regulations. [34][35][36][37] With this type of scheduling system, one resident or one team of residents (designated as the NF resident or team) is assigned to night duty for a number of consecutive nights and relieved of all daytime clinical and academic activities. 38,39 In the McGill cIM program's NF system, at each teaching hospital the NF team is composed of one senior resident (PGY-2 or PGY-3) and one junior resident (PGY-1), who cover both CTUs as well as several other smaller medical inpatient units.…”

Problem niedoboru lekarzy — czy jest na to remedium?

“…Dyżur medyczny to czas poświęcony na pracę, za którą należy się wynagrodzenie. Wymiar czasu pracy lekarzy zależy od ich woli, w świetle czego mogą go legalnie ograniczyć do ustawowego minimum [15][16][17][18][19][20][21][22].…”

Resident duty-hour reform: moving beyond “change for change’s sake”

“…Similar anecdotal reports have been published elsewhere. 6 Further research is needed to explore this aspect in more detail, given that improved resident health is an important driver of duty-hour reform. Whereas many jurisdictions have taken a onesize-fits-all approach to resident duty-hour reform, with standardized limits to the number of consecutive hours worked and/or total hours worked per week, there is increasing interest in a more levelspecific approach.…”