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Effect of a Change in House Staff Work Schedule on Resource Utilization and Patient Care

Effect of a Change in House Staff Work Schedule on Resource Utilization and Patient Care Abstract Concern is frequently expressed by health care providers and consumers that the work environment of physiciansin-training may adversely affect their performance. This article documents the effects of changing from a traditional rotational overnight call schedule for house staff to a schedule designed to reduce sleep deprivation, distribute admissions more evenly throughout the week, and improve continuity of inpatient care on the internal medicine service of a large, university-affiliated Veterans Affairs Medical Center. In a prospective, time-series study, the hypothesis that this change would improve the efficiency and quality of medical care was evaluated by comparing the hospital course of the patients admitted during 4-week periods prior to and following the change in work schedule. The patients in the preintervention group do not differ significantly from those in the postintervention group in any identifiable clinical characteristics. The length of stay was shorter (10.9 vs 9.3 days) and the number of laboratory tests ordered per patient was smaller (24.0 vs 19.0) for patients cared for under the new work schedule compared with those cared for under the traditional work schedule. Resident physicians also committed fewer medication errors under the new work schedule (16.9 vs 12.0 per 100 patients discharged). We conclude that altering the house staff work schedule affects patient care and can lead to a decrease in utilization of health care resources. (Arch Intern Med. 1991;151:2065-2070) References 1. McCue JD. The distress of internship: causes and prevention . N Engl J Med. 1985;312:449-452.Crossref 2. Schroeder SA, Showstack JA, Gerbert B. Residency training in internal medicine: time for a change? Ann Intern Med. 1986;104:554-561.Crossref 3. Amis ES Jr. Residency staffing levels . J Med Educ. 1986;61:782-783. 4. Petersdorf RG. Balancing concerns for quality patient care and quality residency training . J Med Educ. 1988;63:410-411. 5. Asch DA, Parker RM. The Libby Zion case: one step forward or two steps backward? N Engl J Med. 1988;318:771-775.Crossref 6. McCall TB. The impact of long working hours on resident physicians . N Engl J Med. 1988;318:775-778.Crossref 7. Levinsky NG. Compounding the error . N Engl J Med. 1988;318:778-780.Crossref 8. Glickman RM. House-staff training: the need for careful reform . N Engl J Med. 1988;318:780-782.Crossref 9. Lubell A. NY moves to restrict resident, intern work hours . Am Med News. 1988;31:18-22. 10. Association of American Medical Colleges. Resident supervision and hours: recommendations of the Association of American Medical Colleges . J Med Educ. 1988;63:421-426. 11. American College of Physicians. Working conditions and supervision for residents in internal medicine programs: recommendations . Ann Intern Med. 1989;110:657-663.Crossref 12. Friedman RC, Bigger JT, Kornfeld DS. The intern and sleep loss . N Engl J Med. 1971;285:201-203.Crossref 13. Engel W, Seime R, Powell V, D'Alessandri R. Clinical performance of interns after being on call . South Med J. 1987;80:761-763.Crossref 14. Hart RP, Buchsbaum DG, Wade JB, Hamer RM, Kwentus JA. Effect of sleep deprivation on first-year residents' response times, memory, and mood . J Med Educ. 1987;62:940-942. 15. Bartle EJ, Sun JH, Thompson L, Light AI, McCool C, Heaton S. The effects of sleep deprivation during residency training . Surgery. 1988;104:311-316. 16. Beatty J, Ahern SK, Katz R. Sleep deprivation and the vigilance of anesthesiologists during simulated surgery . In: Vigilance: Theory, Operational Performance, and Physiological Correlates . Orlando, Fla: Plenum Press; 1977:1-18. 17. Poulton EC, Hunt GM, Carpenter A, Edwards RS. The performance of junior hospital doctors following reduced sleep and long hours of work . Ergonomics. 1978;21:279-295.Crossref 18. Ford CV, Wentz DK. The internship year: a study of sleep, mood states, and psychophysiologic parameters . South Med J. 1984;77:1435-1442.Crossref 19. Hawkins MR, Vichick DA, Silsby HD, Kruzich DJ, Butler R. Sleep and nutritional deprivation and performance of house officers . J Med Educ. 1985;60:530-535. 20. Reznick RK, Folse JR. Effect of sleep deprivation on the performance of surgical residents . Am J Surg. 1987;154:520-525.Crossref 21. Deaconson TF, O'Hair DP, Levy MF, Lee MB, Schueneman AL, Condon RE. Sleep deprivation and resident performance . JAMA. 1988;260:1721-1727.Crossref 22. Storer JS, Floyd HH, Gill WL, Giusti CW, Ginsburg H. Effects of sleep deprivation on cognitive ability and skills of pediatrics residents . Acad Med. 1989;64:29-32.Crossref 23. Christensen EE, Dietz GW, Murry RC, Moore JG. The effect of fatigue on resident performance . Radiology. 1977;125:103-105.Crossref 24. Wilkinson RT, Taylor PD, Varey CA. Duty hours of young hospital doctors: effects on the quality of work . J Occup Psychol. 1975;48:219-229.Crossref 25. Lofgren RP, Gottlieb DJ, Williams RA, Rich EC. Post-call transfer of resident responsibility: its effect on patient care . J Gen Intern Med. 1990;5:501-505.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Effect of a Change in House Staff Work Schedule on Resource Utilization and Patient Care

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400100131022
Publisher site
See Article on Publisher Site

Abstract

Abstract Concern is frequently expressed by health care providers and consumers that the work environment of physiciansin-training may adversely affect their performance. This article documents the effects of changing from a traditional rotational overnight call schedule for house staff to a schedule designed to reduce sleep deprivation, distribute admissions more evenly throughout the week, and improve continuity of inpatient care on the internal medicine service of a large, university-affiliated Veterans Affairs Medical Center. In a prospective, time-series study, the hypothesis that this change would improve the efficiency and quality of medical care was evaluated by comparing the hospital course of the patients admitted during 4-week periods prior to and following the change in work schedule. The patients in the preintervention group do not differ significantly from those in the postintervention group in any identifiable clinical characteristics. The length of stay was shorter (10.9 vs 9.3 days) and the number of laboratory tests ordered per patient was smaller (24.0 vs 19.0) for patients cared for under the new work schedule compared with those cared for under the traditional work schedule. Resident physicians also committed fewer medication errors under the new work schedule (16.9 vs 12.0 per 100 patients discharged). We conclude that altering the house staff work schedule affects patient care and can lead to a decrease in utilization of health care resources. (Arch Intern Med. 1991;151:2065-2070) References 1. McCue JD. The distress of internship: causes and prevention . N Engl J Med. 1985;312:449-452.Crossref 2. Schroeder SA, Showstack JA, Gerbert B. Residency training in internal medicine: time for a change? Ann Intern Med. 1986;104:554-561.Crossref 3. Amis ES Jr. Residency staffing levels . J Med Educ. 1986;61:782-783. 4. Petersdorf RG. Balancing concerns for quality patient care and quality residency training . J Med Educ. 1988;63:410-411. 5. Asch DA, Parker RM. The Libby Zion case: one step forward or two steps backward? N Engl J Med. 1988;318:771-775.Crossref 6. McCall TB. The impact of long working hours on resident physicians . N Engl J Med. 1988;318:775-778.Crossref 7. Levinsky NG. Compounding the error . N Engl J Med. 1988;318:778-780.Crossref 8. Glickman RM. House-staff training: the need for careful reform . N Engl J Med. 1988;318:780-782.Crossref 9. Lubell A. NY moves to restrict resident, intern work hours . Am Med News. 1988;31:18-22. 10. Association of American Medical Colleges. Resident supervision and hours: recommendations of the Association of American Medical Colleges . J Med Educ. 1988;63:421-426. 11. American College of Physicians. Working conditions and supervision for residents in internal medicine programs: recommendations . Ann Intern Med. 1989;110:657-663.Crossref 12. Friedman RC, Bigger JT, Kornfeld DS. The intern and sleep loss . N Engl J Med. 1971;285:201-203.Crossref 13. Engel W, Seime R, Powell V, D'Alessandri R. Clinical performance of interns after being on call . South Med J. 1987;80:761-763.Crossref 14. Hart RP, Buchsbaum DG, Wade JB, Hamer RM, Kwentus JA. Effect of sleep deprivation on first-year residents' response times, memory, and mood . J Med Educ. 1987;62:940-942. 15. Bartle EJ, Sun JH, Thompson L, Light AI, McCool C, Heaton S. The effects of sleep deprivation during residency training . Surgery. 1988;104:311-316. 16. Beatty J, Ahern SK, Katz R. Sleep deprivation and the vigilance of anesthesiologists during simulated surgery . In: Vigilance: Theory, Operational Performance, and Physiological Correlates . Orlando, Fla: Plenum Press; 1977:1-18. 17. Poulton EC, Hunt GM, Carpenter A, Edwards RS. The performance of junior hospital doctors following reduced sleep and long hours of work . Ergonomics. 1978;21:279-295.Crossref 18. Ford CV, Wentz DK. The internship year: a study of sleep, mood states, and psychophysiologic parameters . South Med J. 1984;77:1435-1442.Crossref 19. Hawkins MR, Vichick DA, Silsby HD, Kruzich DJ, Butler R. Sleep and nutritional deprivation and performance of house officers . J Med Educ. 1985;60:530-535. 20. Reznick RK, Folse JR. Effect of sleep deprivation on the performance of surgical residents . Am J Surg. 1987;154:520-525.Crossref 21. Deaconson TF, O'Hair DP, Levy MF, Lee MB, Schueneman AL, Condon RE. Sleep deprivation and resident performance . JAMA. 1988;260:1721-1727.Crossref 22. Storer JS, Floyd HH, Gill WL, Giusti CW, Ginsburg H. Effects of sleep deprivation on cognitive ability and skills of pediatrics residents . Acad Med. 1989;64:29-32.Crossref 23. Christensen EE, Dietz GW, Murry RC, Moore JG. The effect of fatigue on resident performance . Radiology. 1977;125:103-105.Crossref 24. Wilkinson RT, Taylor PD, Varey CA. Duty hours of young hospital doctors: effects on the quality of work . J Occup Psychol. 1975;48:219-229.Crossref 25. Lofgren RP, Gottlieb DJ, Williams RA, Rich EC. Post-call transfer of resident responsibility: its effect on patient care . J Gen Intern Med. 1990;5:501-505.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1991

References