PURPOSE: Regulatory trends in resident and fellow scheduling include continued reductions in duty hours intended to improve housestaff well-being and patient safety. Duty hour reduction for fellows has the potential to threaten continuity and educational quality and to increase faculty or resident workload. We sought to implement a schedule for fellows with reduced duty hours and enhanced continuity and educational quality, while monitoring perceived faculty workload and housestaff duty hours.
METHODS: We piloted an alternative schedule for Medical Intensive Care Unit fellows for two months and compared it to baseline. During the pilot, fellows worked either a twelve-hour day shift as primary leader of one of the MICU services or on a parallel rotating twelve-hour shift cycle (3 days/3 nights/3 off). During the baseline schedule fellows worked a rotating nine-hour call/30-hour call/post-call/off schedule, or a parallel nine-hour weekday float schedule. The pilot schedule contained no 24-hour call periods and a maximum of 48-72 hours/week. The baseline schedule included overnight call every fourth day and a maximum of 78 hours/week. Faculty physicians were surveyed about perceived workload, workflow, patient care and educational quality. Fellows completed their usual post-rotation evaluations, and both fellows and residents self-reported duty-hour violations.
RESULTS: Fifteen faculty physician surveys were returned (71% response rate). Faculty rated the pilot model favorably in all categories (quality of resident education, fellow education, and patient care, as well as workflow impact), and reported no change in perceived workload. Fellows’ post-rotation evaluations showed increased satisfaction during the pilot. Residents self-reported a decrease in duty hour violations during the pilot.
CONCLUSION: A reduced duty-hour schedule for critical care fellows intended to enhance their educational experience was not associated with increases in perceived faculty workload or duty-hour violations among rotating residents. Faculty and fellows perceived the intervention as an improvement upon the current model with respect to quality of education, patient care, and workflow.
CLINICAL IMPLICATIONS: It may be possible to meet new housestaff scheduling targets without compromising educational quality or increasing faculty workload.
DISCLOSURE: John Litell, No Financial Disclosure Information; No Product/Research Disclosure Information