OBJECTIVE
To measure the effect of duty periods no longer than 16 hours on patient care and
resident education.
PATIENTS AND METHODS
As part of our Educational Innovations Project, we piloted a novel resident schedule
for an inpatient service that eliminated shifts longer than 16 hours without increased
staffing or decreased patient admissions on 2 gastroenterology services from August
29 to November 27, 2009. Patient care variables were obtained through medical record
review. Resident well-being and educational variables were collected by weekly surveys,
end of rotation evaluations, and an electronic card-swipe system.
RESULTS
Patient care metrics, including 30-day mortality, 30-day readmission rate, and length
of stay, were unchanged for the 196 patient care episodes in the 5-week intervention
month compared with the 274 episodes in the 8 weeks of control months. However, residents
felt less prepared to manage cross-cover of patients (P=.006). There was a nonsignificant trend toward decreased perception of quality of
education and balance of personal and professional life during the intervention month.
Residents reported working fewer weekly hours overall during the intervention (64.3
vs 68.9 hours; P=.40), but they had significantly more episodes with fewer than 10 hours off between
shifts (24 vs 2 episodes; P=.004).
CONCLUSION
Inpatient hospital services can be staffed with residents working shifts less than
16 hours without additional residents. However, cross-cover of care, quality of education,
and time off between shifts may be adversely affected.
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Article info
Footnotes
This study was supported in part by the Mayo Clinic Internal Medicine Residency Office of Educational Innovations as part of the ACGME Educational Innovations Project.
Identification
Copyright
© 2011 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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