Shifting perceptions: a pre-post study to assess the impact of a senior resident rotation bundle

Abstract

BackgroundExtended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents’ perceptions of the impact of the bundle on three domains: the senior residents’ wellness, ability to deliver quality health care, and medical education experience.MethodsThis prospective study compared eligible residents’ experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre- and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples.ResultsParticipants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision.ConclusionsThe rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants’ perceptions.

Effect of Fatigue Training on Safety, Fatigue, and Sleep in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review and Meta-Analysis

“…Scott et al used a quasi-experimental design to study nurses working on medical -surgical units in 3 major acute care Michigan hospitals and found a decrease number of errors following fatigue training (p = 0.01) (32). Fabreau et al used a quasi-experimental design to study internal medicine residents at two large academic hospitals in Canada and found that fatigue training was associated with a decrease in the residents' perception of their potential for error (p = 0.003) (36). The pooled effect of these studies was not estimable.…”

“…Four quasi-experimental studies evaluated the impact of fatigue education and training interventions on diverse indicators of long-term health (e.g., selfreported mental health, physical health, and depression symptoms) (12,34,36,39). A pooled effect is not estimable given the diversity in measures and measurement timing.…”

“…Two quasi-experimental studies determined the impact of a fatigue education and training type intervention on outcomes germane to patient safety (i.e., medical errors and quality of care delivery) (32,36). Scott et al used a quasi-experimental design to study nurses working on medical -surgical units in 3 major acute care Michigan hospitals and found a decrease number of errors following fatigue training (p = 0.01) (32).…”

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

“…[22][23][24][25][26][27]31,32 However, in 1 of these studies, 22.6% of respondents reported there was information they did not receive at handoff that would have helped them care for patients. 26 Other studies 22,25,30,33,36,37 noted that respondents reported increased quality of handoffs with an electronic handoff system. In 1 study, residents used 3 different handoff protocols (written, electronic, and face-to-face), with reports of protocol deviations lowest in the face-to-face phase (28%), highest with written handoffs (67%), and electronic handoffs falling in the middle (50%).…”

“…In 1 study, residents used 3 different handoff protocols (written, electronic, and face-to-face), with reports of protocol deviations lowest in the face-to-face phase (28%), highest with written handoffs (67%), and electronic handoffs falling in the middle (50%). 38 In 9 studies (24%), perception of patient safety and/or quality of care improved 22,27,31,36,39 ; better patient management 21,25 or fewer near misses 30 were reported; and there was a reduction in missed patients. 34 However, a randomized crossover study found no statistically significant differences in resident-reported unexpected events, medical errors, or adverse drug events when comparing the electronic handoff system to the standard systems used (ie, written lists, card based, or a team-developed spreadsheet), 40 and another study found no difference in reported unexpected events pre-to postimplementation of a new electronic handoff system.…”