Factors Associated with Non-Compliance During 16-Hour Long Call Shifts

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• 作者：Jed Gonzalo MD (1) (2)
  Shoshana Herzig MD ; MPH (3)
  Eileen Reynolds MD (4)
  Julius Yang MD ; PhD (5)
  
• 关键词：medical education ; graduate ; medical education ; systems ; based practice ; duty hours
• 刊名：Journal of General Internal Medicine
• 出版年：2012
• 出版时间：November 2012
• 年：2012
• 卷：27
• 期：11
• 页码：1424-1431
• 全文大小：1744KB
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• 作者单位：Jed Gonzalo MD (1) (2)
  Shoshana Herzig MD, MPH (3)
  Eileen Reynolds MD (4)
  Julius Yang MD, PhD (5)
  
  1. Chief Medicine Resident and Clinical Teaching Fellow, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
  2. General Internal Medicine Medical Education Fellow, University of Pittsburgh Medical Center/University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  3. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
  4. Internal Medicine Residency Program, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
  5. Silverman Institute for Healthcare Quality and Safety, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
  

文摘

Background Duty hour restrictions limit shift length to 16 hours during the 1st post-graduate year. Although many programs utilize a 16-hour “long call-admitting shift on inpatient services, compliance with the 16-hour shift length and factors responsible for extended shifts have not been well examined. Objective To identify the incidence of and operational factors associated with extended long call shifts and residents-perceptions of the safety and educational value of the 16-hour long call shift in a large internal medicine residency program. Design, Participants, and Main Measures Between August and December of 2010, residents were sent an electronic survey immediately following 16-hour long call shifts, assessing departure time and shift characteristics. We used logistic regression to identify independent predictors of extended shifts. In mid-December, all residents received a second survey to assess perceptions of the long call admitting model. Key Results Two-hundred and thirty surveys were completed (95?%). Overall, 92 of 230 (40?%) shifts included ? team member exceeding the 16-hour limit. Factors independently associated with extended shifts per 3-member team were 3- patients (adjusted OR 5.2, 95?% CI 1.9-4.3) and-gt;- patients (OR 10.6, 95?% CI 3.3-4.6) admitted within 6 hours of scheduled departure and-gt;- total admissions (adjusted OR 2.9, 95?% CI 1.05-.3). Seventy-nine of 96 (82?%) residents completed the perceptions survey. Residents believed, on average, teams could admit 4.5 patients after 5?pm and 7 patients during long call shifts to ensure compliance. Regarding the long call shift, 73?% agreed it allows for safe patient care, 60?% disagreed/were neutral about working too many hours, and 53?% rated the educational value in the top 33?% of a 9-point scale. Conclusions Compliance with the 16-hour long call shift is sensitive to total workload and workload timing factors. Knowledge of such factors should guide systems redesign aimed at achieving compliance while ensuring patient care and educational opportunities.