Reducing Violations to the 80-hour Work Rule with Electronic Health Record to Establish Rapid Culture Change, Does It Work?

Objectives: In our free-standing general surgery residency program, it was noted over the past decade that we had an exorbitant number of resident work hours violations. This resulted in multiple citations from the Accreditation Council for Graduate Medical Education (ACGME) with subsequent probation. To restore accreditation requirements and provide trainees with a balanced learning environment, work hours were restructured. Reporting of work hours in the residency management software was authenticated by the organizational Electronic Health Record (EHR). This quality improvement project evaluated the effectiveness of compliance to the 80-hour work rules in a single rural surgical training residency program with the aid of EHR. Methods: The hours are actively monitored in the residency management software, New-Innovations (NI) and cumulative weekly reports were created. With the design, residents were scheduled to work a maximum of 13 hours per day beginning at 0600 and operating room (OR) time concluding by 1700. During each 4-week rotation, residents were assigned one Friday call, one Saturday call and four hours of transitional call. The primary outcome of this project was the number of resident violations to the 80 hours rule before and after implementation of those measures. The secondary outcomes were the residents’ comparative academic and clinical performances. This project also evaluated the overall cultural change and satisfaction with the program using ACGME survey data. Results: Compared with the non EHR era (2013-2015), the number of violations during the EHR era decreased significantly. (Mean non EHR= 167.3, EHR = 24.6) (p =0.0009) Case volumes and board pass rates were a central focus throughout the changes. No decrease in operative volume was noted for graduating residents (N = 8, non EHR= 1,062, Mean EHR = 1,110) (p = 0.5). Over the three years since the changes, the board pass rates have improved from 64% to 80% in Certifying Examination (CE) (N = 8, Passing % non EHR = 64%, EHR = 80%) (p = 0.03) Qualifying Examination (QE) (N = 8, Passing % non EHR = 100%, EHR = 93%) (p =0.1). Conclusion: Reduction in work hour violations can be achieved with a reliable schedule, promotion of accurate reporting by residents, and monitoring through EHR reports. Adherence to work hour guidelines is essential for resident well-being and a healthy and conducive clinical learning environment without diminishing operative experience.

Addressing Systemic Causes of Physician Burnout: Improving Joy in Work

Healthcare provider burnout has been shown to result in lower staff engagement levels and reduced work satisfaction, which correlates with lower patient experience scores, lower productivity, and increased workplace accidents. By making work engaging and restoring joy, healthcare leadership can reframe barriers to reduce burnout. This paper presents the results of an organizational system-wide intervention designed to rethink the approach to lowering burnout by improving joy in work to address provider well-being at the Guthrie healthcare system. System wide and targeted area strategies were used to create change over a 1-year interval of intervention. After endpoint data was collected, eight power items had positive change for this healthcare system. Scheduling and recognition emerged as system wide areas in need of reform.

Investigating Trends in Elder-Elder Caregiving in the United States: 1997 – 2014

Caregiving is a difficult field to study due to the subjective nature of the data. Insufficient research exists exploring the situation of elder-elder caregiving (where the caregiver is 64 years old or older and caring for a care recipient, who is also 64 years old or older.) This article investigates this relationship to better understand changes in caregiving specific to this population. METHODS: Statistical tests were performed on publicly available data sets from the National Alliance for Caregiving. Data sets were collected via telephone and internet surveys in 1997, 2004, 2009, and 2014, from a random sample of caregivers. RESULTS: 989 responses were analyzed. ANOVA and post-hoc tests found a significant statistical difference (p < 0.0001) between the mean age of elder-elder caregivers for all years when compared to 2014. The largest increase in mean age of elder-elder caregivers was from 70 years old in 2004 to 74 years old in 2014. No correlation was found between elder-elder caregiver age and level of burden experienced due to caregiving. The average length of time of elder-elder caregiving was approximately five years. CONCLUSION: The lack of prior investigation on this population may be concealing the needs of elder-elder caregivers. Further research could help society prioritize education and inform action plans to assist elder-elder caregivers, so that a.) they have a higher quality of life near the end of life, and b.) their caregiving workload does not shift to institutional health care settings.