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

Sun, Ning-Zi; Gan, Runye; Snell, Linda; Dolmans, Diana

doi:10.1097/acm.0000000000000949

Cited by 30 publications

(12 citation statements)

References 49 publications

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“…For example, ownership has been described as ‘knowing everything about one’s patients and doing everything for them’ [ 3 ]; ‘the feeling of accountability’ for a patient and a care plan [ 4 ]; being assigned the care of a patient 24 h a day, 7 days a week; being responsible for the patient’s management and eventual disposition; and being the one person in charge of decision-making [ 6 – 8 ]. Ownership has also been conceptualized as resulting from time invested in the patient’s care and in a longitudinal treatment relationship [ 6 – 8 ] and has been linked with professional attributes of commitment (‘being obligated or emotionally impelled to act in the best interest of the patient’) and presence (‘to be fully present for a patient without distraction and to fully support and accompany the patient throughout care’) [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Understanding ownership of patient care: A dual-site qualitative study of faculty and residents from medicine and psychiatry

et al. 2017

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IntroductionWith changes in duty hours and supervision requirements, educators have raised concerns about erosion of patient care ownership by resident physicians. However, the definition of ownership is unclear. This qualitative study investigated definitions of ownership in medicine and psychiatry faculty and residents.MethodsThe authors distributed an anonymous online survey regarding definitions of ownership to faculty and residents at the psychiatry and internal medicine residency programs at the University of Washington and the Harvard Longwood psychiatry residency and conducted a qualitative analysis of free-text responses to identify emergent themes.Results225 faculty (48.6%) and 131 residents (43.8%) across the three programs responded. Responses yielded themes in five domains: Physician Actions, Physician Attitudes, Physician Identity, Physician Qualities, and Quality of Patient Care. All groups identified themes of advocacy, communication and care coordination, decision-making, follow through, knowledge, leadership, attitudes of going ‘above and beyond’ and ‘the buck stops here’, responsibility, serving as primary provider, demonstrating initiative, and providing the best care as central to ownership. Residents and faculty had differing perspectives on ‘shift work’ and transitions of care and on resident decision-making as elements of ownership.DiscussionThis study expanded and enriched the definition of patient care ownership. There were more similarities than differences across groups, a reassuring finding for those concerned about a decreasing understanding of ownership in trainees. Findings regarding shared values, shift work, and the decision-making role can inform educators in setting clear expectations and fostering ownership despite changing educational and care models.

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Section: Introductionmentioning

confidence: 99%

Understanding ownership of patient care: A dual-site qualitative study of faculty and residents from medicine and psychiatry

et al. 2017

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“…While studies from other fields such as private industry and government may be useful, there are unique aspects of the academic medicine setting that need to be considered when contextualising these interventions. For example, professional hierarchies within medical specialists, the high stress medical environment that includes long work hours and on-call responsibilities, and the physician shortage in certain settings can all exacerbate the risk of unprofessional behaviour [ 14 , 60 – 62 ]. Concerns about retaliation may also prohibit reporting of unprofessional behaviour, therefore allowing the behaviour to continue [ 14 , 60 – 62 ].…”

Section: Discussionmentioning

confidence: 99%

Prevention and management of unprofessional behaviour among adults in the workplace: A scoping review

et al. 2018

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BackgroundUnprofessional behaviour is a challenge in academic medicine. Given that faculty are role models for trainees, it is critical to identify strategies to manage these behaviours. A scoping review was conducted to identify interventions to prevent and manage unprofessional behaviour in any workplace or professional setting.MethodsA search of 14 electronic databases was conducted in March 2016, reference lists of relevant systematic reviews were scanned, and grey literature was searched to identify relevant studies. Experimental and quasi-experimental studies that reported on interventions to prevent or manage unprofessional behaviours were included. Studies that reported impact on any outcome were eligible. Two reviewers independently screened articles and completed data abstraction. Qualitative analysis of the definitions of unprofessional behaviour was conducted. Data were charted to describe the study, participant, intervention and outcome characteristics.Results12,482 citations were retrieved; 23 studies with 11,025 participants were included. The studies were 12 uncontrolled before and after studies, 6 controlled before and after studies, 2 cluster-randomised controlled trials (RCTs), 1 RCT, 1 non-randomised controlled trial and 1 quasi-RCT. Four constructs were identified in the definitions of unprofessional behaviour: verbal and/or non-verbal acts, repeated acts, power imbalance, and unwelcome behaviour. Interventions most commonly targeted individuals (22 studies, 95.7%) rather than organisations (4 studies, 17.4%). Most studies (21 studies, 91.3%) focused on increasing awareness. The most frequently targeted behaviour change was sexual harassment (4 of 7 studies).DiscussionSeveral interventions appear promising in addressing unprofessional behaviour. Most of the studies included single component, in-person education sessions targeting individuals and increasing awareness of unprofessional behaviour. Fewer studies targeted the institutional culture or addressed behaviour change.

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“…The day teams comprise a fixed set of residents for 4 weeks, and the night team residents work overnight shifts for 1–2 consecutive weeks and are relieved of all daytime clinical and academic activities. A detailed description of the study setting, including the night float system, was previously published [9] (See Appendix 1 in the online Supplementary Electronic Material).…”

Section: Methodsmentioning

confidence: 99%

“…Those with experiences with the previous 24-hour scheduling system were asked to contrast their experiences prior to and following the implementation of the new night float system. The interview protocol was previously published [9] (see Appendix 2 of the Electronic Supplementary Material).…”

Section: Methodsmentioning

confidence: 99%

Exploring the evolving concept of ‘patient ownership’ in the era of resident duty hour regulations—experience of residents and faculty in an internal medicine night float system

Masson¹,

Snell²,

Dolmans³

et al. 2019

Perspect Med Educ

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BackgroundDespite the use of ‘patient ownership’ as an embodiment of professionalism and increasing concerns over its loss among trainees, how its development in residents has been affected by duty hour regulations has not been well described. In this qualitative study, we aim to outline the key features of patient ownership in internal medicine, factors enabling its development, and how these have been affected by the adoption of a night float system to comply with duty hour regulations.MethodsIn this qualitative descriptive study, we interviewed 18 residents and 12 faculty internists at one university centre and conducted a thematic analysis of the data focused on the concept of patient ownership.ResultsWe identified three key features of patient ownership: personal concern for patients, professional capacity for autonomous decision-making, and knowledge of patients’ issues. Within the context of a night float system, factors that facilitate development of patient ownership include improved fitness for duty and more consistent interactions with patients/families resulting from working the same shift over consecutive days (or nights). Conversely, the increase in patient handovers, if done poorly, is a potential threat to patient ownership development. Trainees often struggle to develop ownership when autonomy is not supported with supervision and when role-modelling by faculty is lacking.DiscussionThese features of patient ownership can be used to frame discussions when coaching trainees. Residency programs should be mindful of the downstream effects of shift-based scheduling. We propose strategies to optimize factors that enable trainee development of patient ownership.Electronic supplementary materialThe online version of this article (10.1007/s40037-019-00540-9) contains supplementary material, which is available to authorized users.

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

Abstract: Duty hours restrictions, as exemplified by an NF system, have both positive and negative impacts on professionalism. Interventions and training toward effective team-based care are needed to curb emergence of shift-worker mentality.

Cited by 30 publications

References 49 publications

Understanding ownership of patient care: A dual-site qualitative study of faculty and residents from medicine and psychiatry

Understanding ownership of patient care: A dual-site qualitative study of faculty and residents from medicine and psychiatry

Prevention and management of unprofessional behaviour among adults in the workplace: A scoping review

Exploring the evolving concept of ‘patient ownership’ in the era of resident duty hour regulations—experience of residents and faculty in an internal medicine night float system

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

Abstract: Duty hours restrictions, as exemplified by an NF system, have both positive and negative impacts on professionalism. Interventions and training toward effective team-based care are needed to curb emergence of shift-worker mentality.

Cited by 30 publications

References 49 publications

Understanding ownership of patient care: A&nbsp;dual-site qualitative study of faculty and residents from medicine and psychiatry

Understanding ownership of patient care: A&nbsp;dual-site qualitative study of faculty and residents from medicine and psychiatry

Prevention and management of unprofessional behaviour among adults in the workplace: A scoping review

Exploring the evolving concept of ‘patient ownership’ in the era of resident duty hour regulations—experience of residents and faculty in an internal medicine night float system

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Product

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Understanding ownership of patient care: A dual-site qualitative study of faculty and residents from medicine and psychiatry

Understanding ownership of patient care: A dual-site qualitative study of faculty and residents from medicine and psychiatry