Are Resident Work-Hour Limitations Beneficial to the Trauma Profession?

2006 ◽  
Vol 72 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Tara Abraham ◽  
Marilee Freitas ◽  
Spiros Frangos ◽  
Heidi L. Frankel ◽  
Reuven Rabinovici
Keyword(s):  
General Surgery ◽  
National Level ◽  
Work Hours ◽  
Emergency General Surgery ◽  
Duty Hours ◽  
Likert Score ◽  
Resident Work ◽  
Work Hour ◽  
Resident Duty ◽  
Level I

In July 2003, work-hour restrictions were implemented by the Accreditation Council for Graduate Medical Education (ACGME) to limit resident duty hours. Attending surgeon work-hours have not been similarly reduced, and many trauma services have added emergency general surgery responsibilities. We hypothesized that trauma attending/resident work-hour disparity may disincentivize residents from selecting trauma careers and that trauma directors would view ACGME regulations negatively. We conducted a 6-month study of resident and in-house trauma attending self-reported hours at a level I trauma center and sent a questionnaire to 172 national level I trauma directors (TDs) regarding work-hours restrictions. TD survey response rate was 48 per cent; 100 per cent of 15 residents and 6 trauma faculty completed work-hour logs. Attending mean hours (87.1/ wk), monthly calls (5), and shifts >30 hours exceeded that of all resident groups. Case volume was similar. Residents viewed their lifestyle more favorably than the lifestyle of the trauma attending (Likert score 3.6 ± 0.5 vs Likert score 2.5 ± 0.8, P = 0.0003). Seventy-one per cent cited attending work hours and lifestyle as a reason not to pursue a trauma career. Nationally, 80 per cent of trauma surgeons cover emergency general surgery; 40 per cent work greater than 80 hours weekly, compared with <1 per cent of surgical trainees (P < 0.0001). Most TDs feel that residents do not spend more time reading (89%) or operating (96%); 68 per cent feel patient care has suffered as a result of duty-hours restrictions. Seventy-one per cent feel residents will not select trauma surgery as a career as a result of changes in duty hours. Perceived trauma attending/resident work-hour disparity may disincentive trainees from trauma career selection. TDs view resident duty-hour restrictions negatively.

How to Further Decrease the Efficiency of Care at a Level I Trauma Center: Implement the Amended Resident Work Hours

2015 ◽  
Vol 81 (7) ◽  
pp. 698-703
Author(s):  
Thomas J. Schroeppel ◽  
John P. Sharpe ◽  
Louis J. Magnotti ◽  
Jordan A. Weinberg ◽  
Martin A. Croce ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Injury Severity ◽  
Unit Length ◽  
Work Hours ◽  
Resident Work ◽  
Study Population ◽  
Work Hour ◽  
Level I ◽  
Post Period

Work-hour restrictions were amended in 2011 to limit interns to 16 continuous duty hours, essentially requiring a night float system of 12-hour shifts. We hypothesize that there has been no improvement in outcomes after implementation of the amended work-hour restrictions. Outcomes from trauma admissions were queried from the trauma registry from 2009 to 2011 (PRE) and 2011 to 2013 (POST). The primary outcome was mortality with secondary outcomes intensive care unit length of stay (LOS) and LOS. Patients were stratified based on age, mechanism, gender, blood pressure, heart rate, and injury severity (Injury Severity Score, Glasgow Coma Scale, Base Deficit). Outcomes were then compared from admissions PRE to POST. A total of 9178 patients were included in the study population. The mean age was 42 with most being male (72%) and blunt mechanism (81%). Patient populations were well matched except patients in the POST period were slightly older (43 vs 42 years; P = 0.01). Intensive care unit LOS and LOS were higher in the POST period. After adjusted analysis, admission in the POST period was not a predictor of mortality (odds ratio 0.857; confidence interval 0.655–1.12). The POST period was an independent predictor for LOS (β = 0.74; P = 0.002). This study adds to the mounting evidence that the implementation of the amended limits on work hours leads to furthermore decreased efficiency of care.

scholarly journals What Is Known: Examining the Empirical Literature in Resident Work Hours Using 30 Influential Articles

2016 ◽  
Vol 8 (5) ◽  
pp. 795-805 ◽  
Author(s):  
Ingrid Philibert
Keyword(s):  
Patient Safety ◽  
Scientific Literature ◽  
Well Being ◽  
Work Hours ◽  
Small Samples ◽  
Empirical Literature ◽  
Future Research ◽  
Resident Work ◽  
Work Hour ◽  
The Impact

ABSTRACT Background  Examining influential, highly cited articles can show the advancement of knowledge about the effect of resident physicians' long work hours, as well as the benefits and drawbacks of work hour limits. Objective  A narrative review of 30 articles, selected for their contribution to the literature, explored outcomes of interest in the research on work hours—including patient safety, learning, and resident well-being. Methods  Articles were selected from a comprehensive review. Citation volume, quality, and contribution to the evolving thinking on work hours and to the Accreditation Council for Graduate Medical Education standards were assessed. Results  Duty hour limits are supported by the scientific literature, particularly limits on weekly hours and reducing the frequency of overnight call. The literature shows declining hours and call frequency over 4 decades of study, although the impact on patient safety, learning, and resident well-being is not clear. The review highlighted limitations of the scientific literature on resident hours, including small samples and reduced generalizability for intervention studies, and the inability to rule out confounders in large studies using administrative data. Key areas remain underinvestigated, and accepted methodology is challenged when assessing the impact of interventions on the multiple outcomes of interest. Conclusions  The influential literature, while showing the beneficial effect of work hour limits, does not answer all questions of interest in determining optimal limits on resident hours. Future research should use methods that permit a broader, collective examination of the multiple, often competing attributes of the learning environment that collectively promote patient safety and resident learning and well-being.

scholarly journals Correlation Between Self-Reported Resident Duty Hours and Time-Stamped Parking Data

2012 ◽  
Vol 4 (2) ◽  
pp. 254-256 ◽  
Author(s):  
Smitha R. Chadaga ◽  
Angela Keniston ◽  
Dan Casey ◽  
Richard K. Albert
Keyword(s):  
Medical Center ◽  
Daily Basis ◽  
Work Hours ◽  
Parking Garage ◽  
Monthly Basis ◽  
Web Based ◽  
Duty Hours ◽  
Resident Work ◽  
Significant Difference ◽  
Reported Data

Abstract Background Failure to comply with Accreditation Council for Graduate Medical Education-mandated resident work hour limitations can result in citations and shortened accreditation cycles. Many programs assess compliance by collecting self-reports of work hours from each resident. Objectives To examine residents' self-reported assessment of work hours recorded on a daily basis using a Web-based product with electronically recorded times collected as residents entered and exited the parking garage. Methods Study participants consisted of 62 University of Colorado Denver internal medicine residents rotating at Denver Health Medical Center on a monthly basis over a 4-month period. Self-reported data submitted by 60 residents were compared with the times these residents entered and exited from the parking garage at Denver Health Medical Center, as assessed by an electronic badge reader. Results A high level of agreement was found between these two data sets. No significant difference was found between the time-stamped parking data and self-reported Web-based data for resident work hours. Conclusions Residents accurately self-reported their work hours, using a daily Web-based duty hours log when compared to an independent, objective and blinded assessment of work hours.

scholarly journals Work Hour Regulations: Do We Need Further Changes Now? A Survey of Internal Medicine Faculty and Residents

2009 ◽  
Vol 1 (2) ◽  
pp. 201-207 ◽  
Author(s):  
Susan Sloan ◽  
Mahesh Krishnamurthy ◽  
David T. Lyon ◽  
Ghada Mitri ◽  
Iryna Chyshkevych ◽  
...  
Keyword(s):  
The United States ◽  
Work Hours ◽  
First Year ◽  
Institute Of Medicine ◽  
Resident Work ◽  
Work Hour ◽  
Internal Medicine Faculty ◽  
Home Residency ◽  
Residency Program Directors ◽  
Resident Work Hours

Abstract Background In 2003, the Accreditation Council for Graduate Medical Education standardized and regulated work hours for physicians in training in the United States. In December 2008, the Institute of Medicine (IOM) recommended further reductions in duty hours to ensure safer conditions for patients and residents and fellows. Significantly, the IOM committee acknowledged that there are barriers to implementing its recommendations. Methods In the wake of the IOM proposals, we chose to survey a reference closer to home: residency program directors, faculty, and residents. Our survey allowed them the opportunity to express their opinions regarding the IOM proposals. Results The majority of the faculty oppose the proposed IOM changes, arguing that there is no definite evidence to support the hypothesis that fewer work hours mean better outcomes in patient safety and education. First-year residents and residents who moonlight were more likely to experience stress and to support decreased work hours. Conclusions The thoughts and opinions of faculty and residents collected through this survey, in combination with evidence-based studies from trial implementation of these standards, will contribute real answers to the challenging questions on resident work hours.

scholarly journals Tides of change

2014 ◽  
Vol 82 (2) ◽  
pp. 4-5
Author(s):  
Jouseph Barkho
Keyword(s):  
United States ◽  
Patient Safety ◽  
Task Force ◽  
The United States ◽  
Medical Resident ◽  
Negative Effects ◽  
Duty Hours ◽  
The Past ◽  
Work Hour ◽  
Resident Duty

The paradigm of medical resident duty hours is currently undergoing vast changes, as research has demonstrated the negative effects of sleep deprivation on the wellbeing of both patients and residents alike. These changes began in the United States, where reduced work hour schedules for residents have been implemented within the past decade. However, the effectiveness of these changes has been debated in the literature. In Canada, this issue has only recently come into spotlight. Under the guidance of the Royal College of Physicians and Surgeons of Canada, a task force was assembled in 2012 with two main objectives: gather all evidence related to resident duty hours, fatigue, and patient safety, and to create a national Canadian consensus on resident duty hours.

Local and National Trends in General Surgery Residents’ Operative Experience: Do Work Hour Limitations Negatively Affect Case Volume in Small Community-Based Programs?

2011 ◽  
Vol 77 (12) ◽  
pp. 1675-1680 ◽  
Author(s):  
Alexey Markelov ◽  
Aniket Sakharpe ◽  
Harjeet Kohli ◽  
David Livert
Keyword(s):  
General Surgery ◽  
Alimentary Tract ◽  
Community Hospital ◽  
National Level ◽  
Small Community ◽  
Case Volume ◽  
Community Based ◽  
Significant Difference ◽  
Work Hour ◽  
The Impact

The goals of this study were to analyze the impact of work hour restrictions on the operative case volume at a small community-based general surgery residency training program and compare changes with the national level. Annual national resident case log data from Accreditation Council for Graduate Medical Education (ACGME) website and case logs of graduating Easton Hospital residents (years 2002-2009) were used for analysis. Weighted average change in total number of cases in our institution was —1.20 ( P = 0.52) vs 1.78 ( P = 0.07) for the national program average with statistically significant difference on comparison ( P = 0.027). We also found significant difference in case volume changes at the national level compared with our institution for the following ACGME defined subcategories: alimentary tract [8.19 ( P < 0.01) vs -1.08 ( P = 0.54)], abdomen [8.48 ( P < 0.01) vs -6.29 ( P < 0.01)], breast [1.91 ( P = 0.89) vs -3.6 ( P = 0.02)], and vascular [4.03 ( P = 0.02) vs -3.98 ( P = 0.01)]. Comparing the national trend to the community hospital we see that there is total increase in cases at the national level whereas there is a decrease in case volume at the community hospital. These trends can also be followed in ACGME defined subcategories which form the major case load for a general surgical training such as alimentary tract, abdominal, breast, and vascular procedures. We hypothesize that work hour restrictions have been favorable for the larger programs, as these programs were able to better integrate the night float system, restructure their call schedule, and implement institutional modifications which are too resource demanding for smaller training programs.

The Nasal Fracture Algorithm: A Case for Protocol-Driven Management to Optimize Care and Resident Work Hours

2017 ◽  
Vol 156 (6) ◽  
pp. 1041-1043 ◽  
Author(s):  
Alexander Lanigan ◽  
Joshua Lospinoso ◽  
Sarah N. Bowe ◽  
Adrienne M. Laury
Keyword(s):  
Nasal Bone ◽  
Resident Training ◽  
Work Hours ◽  
Surgical Resident ◽  
Resident Work ◽  
Fracture Management ◽  
Work Hour ◽  
Resident Time ◽  
Potential Improvement ◽  
Nasal Fractures

Since the initiation of resident duty hour restrictions, significant controversy has arisen regarding its impact on surgical resident training. We reviewed a singular facet of the otolaryngology residency experience, nasal bone fracture management, to identify if treatment standardization would improve care and efficiency. For 1 year, otolaryngology consults for isolated nasal fractures were analyzed to assess consultation trends, rate of intervention, and resident work hour utilization. Following a review of the literature, an evidence-based algorithm for management of nasal fractures was developed. Analysis revealed a potential improvement in intervention rate from 20% to 100% with utilization of the algorithm, with an 84% decrease in overall emergency room and inpatient consultations. Sixty-three hours of otherwise lost resident time would be gained. In the setting of Accreditation for Graduate Medical Education duty hour restrictions, implementation of protocol-driven management may result in a decrease in work hours and serve as a model for more efficient otolaryngology care.

scholarly journals Transforming Ward Rounds Through Rounding-in-Flow

2014 ◽  
Vol 6 (4) ◽  
pp. 750-755 ◽  
Author(s):  
Alvin S. Calderon ◽  
C. Craig Blackmore ◽  
Barbara L. Williams ◽  
Kavita P. Chawla ◽  
Dana L. Nelson-Peterson ◽  
...  
Keyword(s):  
Medical Center ◽  
Clinical Care ◽  
Temporal Trends ◽  
Patient Discharge ◽  
Patient Care Team ◽  
Work Hours ◽  
Actual Patient ◽  
Resident Work ◽  
Resident Duty ◽  
Ward Rounds

Abstract Background Traditional “batched” bedside clinical care rounds, where rounds for all patients precede clinical tasks, may delay clinical care and reduce resident work efficiency. Innovation Using Lean concepts, we developed a novel “Rounding-in-Flow” approach, with the patient care team completing all tasks for a single patient before initiating any tasks for the next patient. Outcome measures included timely patient discharge and intern work hours. Methods We performed a retrospective cohort study with historic and contemporaneous control groups, with time series adjustment for underlying temporal trends at a single medical center. Primary outcomes were timely patient discharge orders and resident duty hours. Participants were 17 376 consecutive hospital inpatients between January 1, 2011, and June 30, 2012, and medical ward rounding teams of interns, residents, and attending hospitalists. Results Timely discharge orders, defined as written by 9:00 am, improved from 8.6% to 26.6% (OR, 1.55; 95% CI 1.17–2.06; P  =  .003). Time of actual patient discharge was unchanged. Resident duty hour violations, defined as less than 10 hours between clinical duties, decreased from 2.96 to 0.98 per intern per rotation (difference, 1.98; 95% CI 1.09–2.87; P &lt; .001). Average daily intern work hours decreased from 12.3 to 11.9 hours (difference, 0.4 hours; 95% CI 0.16–0.69; P  =  .002). Conclusions Compared with batched rounding, Lean Rounding-in-Flow using “1-piece flow” principles was associated with more discharge orders written before 9:00 am and fewer violations in the 10-hour break rule, with minimal changes to intern total work hours and actual patient discharge time.

Impact of Implementing an Electronic Health Record on Surgical Resident Work Flow, Duty Hours, and Operative Experience

2015 ◽  
Vol 81 (2) ◽  
pp. 172-177 ◽  
Author(s):  
Blair A. Wormer ◽  
Paul D. Colavita ◽  
William T. Yokeley ◽  
Joel F. Bradley ◽  
Kristopher B. Williams ◽  
...  
Keyword(s):  
Work Hours ◽  
Work Flow ◽  
Health Record ◽  
Surgical Resident ◽  
Duty Hours ◽  
Resident Work ◽  
Resident Time ◽  
Operative Experience ◽  
Paper Documentation ◽  
Resident Work Hours

Our objective was to assess the effect of implementing an electronic health record (EHR) on surgical resident work flow, duty hours, and operative experience at a large teaching hospital. In May 2012, an EHR was put into effect at our institution replacing paper documentation and orders. Resident time to complete patient documentation, average duty hours, and operative experience before EHR and afterward (at 1, 4, 6, 8, and 24 weeks) were surveyed. We obtained 100 per cent response rate from 15 surgical residents at all time intervals. The average time spent documenting before EHR was 9 ± 2 minutes per patient document and at Weeks 1, 4, 6, 8, and 24 after EHR implementation was 22 ± 10, 15 ± 7, 15 ± 7, 14 ± 8, and 12 ± 4 minutes, respectively. Repeated measures analysis of variance demonstrated a difference among the means ( P < 0.0001). Discharge summary and operative note remained significantly longer to complete at Week 24 compared with paper documentation ( P < 0.05). Average resident work hours and operative cases per week before EHR were 77 ± 5 hours and 12 ± 5 cases, respectively, which were similar at all time points after EHR implementation ( P > 0.05). At 24 weeks after EHR, 74 per cent of residents felt their risk of performing a medical error using electronic documentation and order entry was higher compared with paper charting and orders. Transition to EHR led to a significant doubling in resident time spent performing documentation for each patient. It improved over 6 months after implementation but never reached the pre-EHR baseline for operative notes and discharge summaries. Average resident work hours and case logs remained similar during this transition.

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