Effects of resident shift length, protected sleep time and night float on patient care and residents’ health

2011 ◽  
Vol 16 (2) ◽  
Keyword(s):  
Patient Care ◽  
Sleep Time ◽  
Night Float ◽  
Shift Length

Resident-faculty overnight discrepancy rates as a function of number of consecutive nights during a week of night float

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Christine Peterson ◽  
Michael Moore ◽  
Nabeel Sarwani ◽  
Eric Gagnon ◽  
Michael A. Bruno ◽  
...  
Keyword(s):  
Progressive Increase ◽  
Recent Change ◽  
Final Report ◽  
Quality Performance ◽  
Resident Performance ◽  
Night Float ◽  
Perceived Workload ◽  
Report Accuracy ◽  
Shift Length ◽  
The Voice

AbstractObjectivesIn 2018, the ACGME (Accreditation Council for Graduate Medical Education) made a change to the maximum permissible number of consecutive nights a resident trainee can be on “night float,” from six to seven nights. To our knowledge, although investigators have studied overall discrepancy rates and discrepancy rates as a function of shift length or perceived workload of a particular shift, no study has been performed to evaluate resident-faculty discrepancy rates as a quality/performance proxy, to see whether resident performance declines as a function of the number of consecutive nights. Our hypothesis is that we would observe a progressive increase in significant overnight resident – attending discrepancies over the 7 days’ time.MethodsA total of 8,488 reports were extracted between 4/26/2019 to 8/22/2019 retrospectively. Data was obtained from the voice dictation system report server. Exported query was saved as a .csv file format and analyzed using Python packages. A “discrepancy checker” was created to search all finalized reports for the departmental standard heading of “Final Attending Report,” used to specify any significant changes from the preliminary interpretation.ResultsModel estimates varied on different days however there were no trends or patterns to indicate a deterioration in resident performance throughout the week. There were comparable probabilities throughout the week, with 2.17% on Monday, 2.35% on Thursday and 2.05% on Friday.ConclusionsOur results reveal no convincing trend in terms of overnight report discrepancies between the preliminary report generated by the night float resident and the final report issued by a faculty the following morning. These results are in support of the ACGME’s recent change in the permissible number of consecutive nights on night float. We did not prove our hypothesis that resident performance on-call in the domain of report accuracy would diminish over seven consecutive nights while on the night float rotation. Our results found that performance remained fairly uniform over the course of the week.

Effects of shift length on quality of patient care and health provider outcomes: systematic review

2009 ◽  
Vol 18 (3) ◽  
pp. 181-188 ◽  
Author(s):  
C A Estabrooks ◽  
G G Cummings ◽  
S A Olivo ◽  
J E Squires ◽  
C Giblin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Care ◽  
Health Provider ◽  
Quality Of Patient Care ◽  
Shift Length ◽  
Provider Outcomes

scholarly journals A Night Float System in Nephrology Fellowship: A Mixed Methods Evaluation

Kidney360 ◽  
2020 ◽  
Vol 1 (7) ◽  
pp. 631-639
Author(s):  
Jennifer B. Plotkin ◽  
Eric J. Xu ◽  
Derek M. Fine ◽  
Daphne H. Knicely ◽  
C. John Sperati ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Group ◽  
Patient Care ◽  
Night Float ◽  
Mixed Methods Evaluation ◽  
Included Patient ◽  
Quality Of Patient Care ◽  
Positive Effect ◽  
Neutral Effect

BackgroundJohns Hopkins was an early adopter of an in-house nephrology fellowship night float to improve work-life balance. Our study aimed to elucidate attitudes to guide fellowship structuring.MethodsWe performed a mixed-methods study surveying Johns Hopkins fellows, alumni, and faculty and conducting one focus group of current fellows. Surveys were developed through literature review, queried on a five-point Likert scale, and analyzed with t and ANOVA tests. The focus group transcript was analyzed by two independent reviewers.ResultsSurvey response rates were 14 (100%) fellows, 32 (91%) alumni, and 17 (94%) faculty. All groups felt quality of patient care was good to excellent with no significant differences among groups (range of means [SD], 4.1 [0.7]–4.6 [0.7]; P=0.12), although fellows had a statistically significantly more positive view than faculty on autonomy (4.6 [0.5] versus 4.1 [0.3]; P=0.006). Fellows perceived a positive effect across all domains of night float on the day team experience (range, 4.2 [0.8]–4.6 [0.6]; P<0.001 compared with neutral effect). Focus group themes included patient care, care continuity, professional development, wellness, and structural components. One fellow said, “…my bias is that every program would switch to a night float system if they could.” All groups were satisfied with night float with 4.7 [0.5], 4.2 [0.8], and 4.0 [0.9] for fellows, faculty, and alumni, respectively; fellows were most enthusiastic (P=0.03). All three groups preferred night float, and fellows did so unanimously.ConclusionsNight float was well liked and enhanced the perceived daytime fellow experience. Alumni and faculty were positive about night float, although less so, possibly due to concerns for adequate preparation to handle overnight calls after graduation. Night float implementation at other nephrology programs should be considered based on program resources; such changes should be assessed by similar methods.

scholarly journals The Effect of Restricting Residents' Duty Hours on Patient Safety, Resident Well-Being, and Resident Education: An Updated Systematic Review

2015 ◽  
Vol 7 (3) ◽  
pp. 349-363 ◽  
Author(s):  
Lauren Bolster ◽  
Liam Rourke
Keyword(s):  
Systematic Review ◽  
Patient Care ◽  
Resident Education ◽  
Negative Impact ◽  
Well Being ◽  
Duty Hours ◽  
Night Float ◽  
Protected Time ◽  
Resident Wellness ◽  
The Impact

ABSTRACT Background Despite 25 years of implementation and a sizable amount of research, the impact of resident duty hour restrictions on patients and residents still is unclear. Advocates interpret the research as necessitating immediate change; opponents draw competing conclusions. Objective This study updates a systematic review of the literature on duty hour restrictions conducted 1 year prior to the implementation of the Accreditation Council for Graduate Medical Education's 2011 regulations. Methods The review draws on reports catalogued in MEDLINE and PreMEDLINE from 2010 to 2013. Interventions that dealt with the duty hour restrictions included night float, shortened shifts, and protected time for sleep. Outcomes were patient care, resident well-being, and resident education. Studies were excluded if they were not conducted in patient care settings. Results Twenty-seven studies met the inclusion criteria. Most frequently, the studies concluded that the restrictions had no impact on patient care (50%) or resident wellness (47%), and had a negative impact on resident education (64%). Night float was the most frequent means of implementing duty hour restrictions, yet it yielded the highest proportion of unfavorable findings. Conclusions This updated review, including 27 recent applicable studies, demonstrates that focusing on duty hours alone has not resulted in improvements in patient care or resident well-being. The added duty hour restrictions implemented in 2011 appear to have had an unintended negative impact on resident education. New approaches to the issue of physician fatigue and its relationship to patient care and resident education are needed.

scholarly journals Anesthesiology Resident Night Float Duty Alters Sleep Patterns

2019 ◽  
Vol 131 (2) ◽  
pp. 401-409 ◽  
Author(s):  
Lauren K. Dunn ◽  
Amanda M. Kleiman ◽  
Katherine T. Forkin ◽  
Allison J. Bechtel ◽  
Stephen R. Collins ◽  
...  
Keyword(s):  
Eye Movement ◽  
Total Sleep Time ◽  
Night Shift ◽  
Sleep Onset ◽  
Sleep Time ◽  
Rapid Eye Movement ◽  
Rapid Eye Movement Sleep ◽  
Consecutive Night ◽  
Sleep Patterns ◽  
Night Float

AbstractEditor’s PerspectiveWhat We Already Know about This TopicWhat This Article Tells Us That Is NewBackgroundResidency programs utilize night float systems to adhere to duty hour restrictions; however, the influence of night float on resident sleep has not been described. The study aim was to determine the influence of night float on resident sleep patterns and quality of sleep. We hypothesized that total sleep time decreases during night float, increases as residents acclimate to night shift work, and returns to baseline during recovery.MethodsThis was a single-center observational study of 30 anesthesia residents scheduled to complete six consecutive night float shifts. Electroencephalography sleep patterns were recorded during baseline (three nights), night float (six nights), and recovery (three nights) using the ZMachine Insight monitor (General Sleep Corporation, USA). Total sleep time; light, deep, and rapid eye movement sleep; sleep efficiency; latency to persistent sleep; and wake after sleep onset were observed.ResultsMean total sleep time ± SD was 5.9 ± 1.9 h (3.0 ± 1.2.1 h light; 1.4 ± 0.6 h deep; 1.6 ± 0.7 h rapid eye movement) at baseline. During night float, mean total sleep time was 4.5 ± 1.8 h (1.4-h decrease, 95% CI: 0.9 to 1.9, Cohen’s d = –1.1, P &lt; 0.001) with decreases in light (2.2 ± 1.1 h, 0.7-h decrease, 95% CI: 0.4 to 1.1, d = –1.0, P &lt; 0.001), deep (1.1 ± 0.7 h, 0.3-h decrease, 95% CI: 0.1 to 0.4, d = –0.5, P = 0.005), and rapid eye movement sleep (1.2 ± 0.6 h, 0.4-h decrease, 95% CI: 0.3 to 0.6, d = –0.9, P &lt; 0.001). Mean total sleep time during recovery was 5.4 ± 2.2 h, which did not differ significantly from baseline; however, deep (1.0 ± 0.6 h, 0.4-h decrease, 95% CI: 0.2 to 0.6, d = –0.6, P = 0.001 *, P = 0.001) and rapid eye movement sleep (1.2 ± 0.8 h, 0.4-h decrease, 95% CI: 0.2 to 0.6, d = –0.9, P &lt; 0.001 P &lt; 0.001) were significantly decreased.ConclusionsElectroencephalography monitoring demonstrates that sleep quantity is decreased during six consecutive night float shifts. A 3-day period of recovery is insufficient for restorative sleep (rapid eye movement and deep sleep) levels to return to baseline.

scholarly journals On-site Night Float by Attending Physicians: A Model to Improve Resident Education and Patient Care

2010 ◽  
Vol 2 (1) ◽  
pp. 57-61 ◽  
Author(s):  
Andrew Paul DeFilippis ◽  
Ildefonso Tellez ◽  
Neil Winawer ◽  
Lorenzo Di Francesco ◽  
Kimberly D. Manning ◽  
...  
Keyword(s):  
Patient Care ◽  
Resident Education ◽  
Treatment Plan ◽  
Diagnostic Procedures ◽  
Institute Of Medicine ◽  
Night Float ◽  
Quality Of Patient Care ◽  
Attending Physician ◽  
The Impact

Abstract Background In 2003, the Accreditation Council for Graduate Medical Education instituted common duty hour limits, and in 2008 the Institute of Medicine recommended additional limits on continuous duty hours. Using a night-float system is an accepted approach for adhering to duty hour mandates. Objective To determine the effect of an on-site night-float attending physician on resident education and patient care. Methods Night-float residents and daytime ward residents were surveyed at the end of their rotation about the impact of an on-site night-float attending physician on education and quality of patient care. Responses were provided on a 5-point Likert scale ranging from 1, strongly agree, to 5, strongly disagree. Results Overall, 92 of the 140 distributed surveys were completed (66% response rate). Night-float residents found the night-float attending physician to be helpful with cross-cover issues (mean  =  2.00), initial history and physical examination (mean  =  1.56), choosing appropriate diagnostic tests (mean  =  1.79), developing a treatment plan (mean  =  1.74), and improving overall patient care (mean  =  1.91). Daytime ward residents were very satisfied with the quality of the admission workups (mean  =  1.78), tests and diagnostic procedures (mean  =  1.76), and initial treatment plan (mean  =  1.62) provided by the night-float service. Conclusion A night-float system that includes on-site attending physician supervision can provide a valuable opportunity for resident education and may help improve the quality of patient care.

Communications problems affecting patient care in hospitals

JAMA ◽  
1966 ◽  
Vol 195 (1) ◽  
pp. 36-37 ◽  
Author(s):  
J. C. Quint
Keyword(s):  
Patient Care

Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

2014 ◽  
Vol 4 (1) ◽  
pp. 23-29
Author(s):  
Constance Hilory Tomberlin
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Patient Care ◽  
Health Care System ◽  
Gulf Coast ◽  
New Technology ◽  
Cost Effective ◽  
Veterans Health ◽  
Potential Benefits ◽  
Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

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