Development of a Night Float Call Model for Obstetrics and Gynaecology Residency: The Process and Residents' Perceptions

Sterling, Lynn; McCaffrey, Carmen; Secter, Michael; Rich, Rebecca; Green, Jessica; Shirreff, Lindsay; Steele, Donna

doi:10.1016/j.jogc.2016.06.015

Cited by 12 publications

(10 citation statements)

References 13 publications

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“…To reflect this, in 2003, the ACGME already set an 80-hour workweek limit for 4 weeks, and the same agency added a 16-hour continuous work restriction in 2011 [11]. Accordingly, many institutions have introduced a NF system in order to comply with the working hours of residents [1213].…”

Section: Discussionmentioning

confidence: 99%

Implementation of a resident night float system in a surgery department in Korea for 6 months: electronic medical record-based big data analysis and medical staff survey

Choi

Park

et al. 2019

Ann Surg Treat Res

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Purpose To evaluate superiority of a night float (NF) system in comparison to a traditional night on-call (NO) system for surgical residents at a single institution in terms of efficacy, safety, and satisfaction. Methods A NF system was implemented from March to September 2017 and big data analysis from electronic medical records was performed for all patients admitted for surgery or contacted from the emergency room (ER). Parameters including vital signs, mortality, and morbidity rates, as well as promptness of response to ER calls, were compared against a comparable period (March to September 2016) during which a NO system was in effect. A survey was also performed for physicians and nurses who had experienced both systems. Results A total of 150,000 clinical data were analyzed. Under the NO and NF systems, a total of 3,900 and 3,726 patients were admitted for surgery. Mortality rates were similar but postoperative bleeding was significantly higher in the NO system (0.5% vs. 0.2%, P = 0.031). From the 1,462 and 1,354 patients under the NO and NF systems respectively, that required surgical consultation from the ER, the time to response was significantly shorter in the NF system (54.5 ± 70.7 minutes vs. 66.8 ± 83.8 minutes, P < 0.001). Both physicians (90.4%) and nurses (91.4%) agreed that the NF system was more beneficial. Conclusion This is the first report of a NF system using big data analysis in Korea, and potential benefits of this new system were observed in both ward and ER patient management.

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Section: Discussionmentioning

confidence: 99%

Implementation of a resident night float system in a surgery department in Korea for 6 months: electronic medical record-based big data analysis and medical staff survey

Choi

Park

et al. 2019

Ann Surg Treat Res

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“…18 In obstetrics and gynecology, residents reported reduced fatigue, improved continuity of patient care, and no adverse effects on surgical experience or quality of life after the transition to four consecutive night float shifts. 19 In a pilot study, urology residents were assigned to one of three schedules: a 12-h day shift (Monday through Friday), 12-h night float (Sunday through Friday), or 24-h home call, and actigraphy was used to measure total sleep time, sleep latency, and depth of sleep. There was no change in total sleep time or quality of sleep with night float compared to day shift or 24-h call.…”

Section: Discussionmentioning

confidence: 99%

Anesthesiology Resident Night Float Duty Alters Sleep Patterns

et al. 2019

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Residency programs utilize night float systems to adhere to duty hour restrictions; however, the influence of night float on resident sleep has not been described. The study aim was to determine the influence of night float on resident sleep patterns and quality of sleep. We hypothesized that total sleep time decreases during night float, increases as residents acclimate to night shift work, and returns to baseline during recovery. Methods This was a single-center observational study of 30 anesthesia residents scheduled to complete six consecutive night float shifts. Electroencephalography sleep patterns were recorded during baseline (three nights), night float (six nights), and recovery (three nights) using the ZMachine Insight monitor (General Sleep Corporation, USA). Total sleep time; light, deep, and rapid eye movement sleep; sleep efficiency; latency to persistent sleep; and wake after sleep onset were observed. Results Mean total sleep time ± SD was 5.9 ± 1.9 h (3.0 ± 1.2.1 h light; 1.4 ± 0.6 h deep; 1.6 ± 0.7 h rapid eye movement) at baseline. During night float, mean total sleep time was 4.5 ± 1.8 h (1.4-h decrease, 95% CI: 0.9 to 1.9, Cohen’s d = –1.1, P < 0.001) with decreases in light (2.2 ± 1.1 h, 0.7-h decrease, 95% CI: 0.4 to 1.1, d = –1.0, P < 0.001), deep (1.1 ± 0.7 h, 0.3-h decrease, 95% CI: 0.1 to 0.4, d = –0.5, P = 0.005), and rapid eye movement sleep (1.2 ± 0.6 h, 0.4-h decrease, 95% CI: 0.3 to 0.6, d = –0.9, P < 0.001). Mean total sleep time during recovery was 5.4 ± 2.2 h, which did not differ significantly from baseline; however, deep (1.0 ± 0.6 h, 0.4-h decrease, 95% CI: 0.2 to 0.6, d = –0.6, P = 0.001 *, P = 0.001) and rapid eye movement sleep (1.2 ± 0.8 h, 0.4-h decrease, 95% CI: 0.2 to 0.6, d = –0.9, P < 0.001 P < 0.001) were significantly decreased. Conclusions Electroencephalography monitoring demonstrates that sleep quantity is decreased during six consecutive night float shifts. A 3-day period of recovery is insufficient for restorative sleep (rapid eye movement and deep sleep) levels to return to baseline.

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“…In 2003, the Accreditation Council for Graduate Medical Education (ACGME) In the United States the limited the working hours to 80 hours per week which restricted overnight shift length and assigned minimum out of duty hours between shifts. In 2011, Quebec province in Canada restricted duty hours to not exceed more than 16 hours for a shift [10]. Also, Europe has implemented residents' duty hour restrictions.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Resident’s Perception of Night Float System Compared to 24 Hours System, a Prospective Study

Alsohime

Alkhalaf

Almuzini

et al. 2020

Preprint

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Background: This study aims to evaluate the pediatric residents’ perceptions of the Night Float (NF) on-call system and its impact on their well-being, education and patient safety and compare it with the previous traditional 24-hour on-call system. Methods: This is a prospective study conducted in two pediatric residents training centers who applied the NF on call system as a pilot project. The senior residents enrolled in the two training centers were invited to participate in this study before changing the on-call system and 6 months after starting the new NF on-call system. A self-administered online questionnaire was distributed to them. A five-point Likert-type scale was used to rank the residents’ responses, covering three main domains; residents’ well-being, ability to deliver health care, and their medical education experience. Pre- and post-intervention scores were presented as means and compared using the t-test for paired samples. Results: A total of 42 residents participated in the survey. Of these, 24 (57.1%) were females. All participants were senior residents; 25 (59.6%) were third year residents while 17 (40.4%) were fourth year residents. Participants felt that most aspects of the three domains were improved by the introduction of the NF system. The NF system had less adverse health effect on the residents (Mean 2.37±1.01), compared to the 24 hours on-call system (Mean 4.19±0.60), P ˂0.001. The NF system had less exposure to personal harm, less negative impact on the quality of care, better work efficiency, reduced potential for medical error, more successful teaching and fewer disruptions to other rotations compared to the 24 hours on-call system, (P ˂0.001). Conclusion: In this study, we found that the NF on-call system positively impacts residents’ well-being, education and patient care. This pilot study demonstrates that the restricted duty hours are useful from pedagogic aspect and sets the ground for Pediatric residency training programs in Saudi Arabia to consider resident duty hour reform. Trial registration: Not applicable

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Development of a Night Float Call Model for Obstetrics and Gynaecology Residency: The Process and Residents' Perceptions

Cited by 12 publications

References 13 publications

Implementation of a resident night float system in a surgery department in Korea for 6 months: electronic medical record-based big data analysis and medical staff survey

Implementation of a resident night float system in a surgery department in Korea for 6 months: electronic medical record-based big data analysis and medical staff survey

Anesthesiology Resident Night Float Duty Alters Sleep Patterns

Pediatric Resident’s Perception of Night Float System Compared to 24 Hours System, a Prospective Study

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