Evening Continuity Clinic: Preserving Primary Care Education in the Face of Duty Hour Limitations?

Kuo, Anda K.; Christine, T.; Kamei, Robert

doi:10.1367/a03-167r.1

Cited by 7 publications

(4 citation statements)

References 4 publications

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“…Other studies used interviews [ 39 ], single-blind intervention [ 55 ], randomized crossover [ 56 ], impact evaluation [ 57 ], program evaluation [ 58 ], prospective self-controlled trial [ 59 ], data review [ 60 ], and retrospective cohort design [ 61 ]. Together these studies assessed organizational measures, including relationships among staff [ 39 , 40 , 62 ], work satisfaction [ 43 , 44 , 58 ], continuity of care [ 39 , 40 , 48 , 50 ], workflow [ 49 , 51 , 56 ], compliance [ 38 , 42 , 45 , 46 , 49 , 51 , 52 , 54 , 57 , 58 , 60 ], workload [ 40 , 41 , 43 , 52 - 54 , 59 , 60 ], and cost [ 51 , 61 ]. Interventions included using new technologies to improve handovers and communication [ 42 , 49 , 56 ], changing staff mixes [ 39 - 41 , 43 , 51 , 53 , 58 , 61 ], and implementing new shift structures [ 38 , 44 - 48 , 50 - 52 , 54 , 55 , 57 - 60 ], each of which had varying effects on the above-stated organizational measures.…”

Section: Resultsmentioning

confidence: 99%

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Organizational interventions in response to duty hour reforms

2014

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BackgroundChanges in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations. This paper examines, and assesses the impact of, organizational interventions that were a direct response to these duty hour reforms.MethodsThe academic literature was searched through the SCOPUS database using the search terms “resident duty hours” and “European Working Time Directive,” together with terms related to organizational factors. The search was limited to English-language literature published between January 2003 and January 2012. Studies were included if they reported an organizational intervention and measured an organizational outcome.ResultsTwenty-five articles were included from the United States (n = 18), the United Kingdom (n = 5), Hong Kong (n = 1), and Australia (n = 1). They all described single-site projects; the majority used post-intervention surveys (n = 15) and audit techniques (n = 4). The studies assessed organizational measures, including relationships among staff, work satisfaction, continuity of care, workflow, compliance, workload, and cost. Interventions included using new technologies to improve handovers and communications, changing staff mixes, and introducing new shift structures, all of which had varying effects on the organizational measures listed previously.ConclusionsLittle research has assessed the organizational impact of duty hour reforms; however, the literature reviewed demonstrates that many organizations are using new technologies, new personnel, and revised and innovative shift structures to compensate for reduced resident coverage and to decrease the risk of limited continuity of care. Future research in this area should focus on both micro (e.g., use of technology, shift changes, staff mix) and macro (e.g., culture, leadership support) organizational aspects to aid in our understanding of how best to respond to these duty hour reforms.

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Section: Resultsmentioning

confidence: 99%

“…In one US study, an evening continuity clinic was implemented to replace a post-call clinic. This system was viewed positively by the residents, but was deemed to have a negative impact on the continuity of preceptors and access to medical services [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

Organizational interventions in response to duty hour reforms

2014

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“…With the duty-hour limitations implemented in 2003 and the subsequent reduction in time available for outpatient duties, it has become increasingly difficult to provide high-quality medical education experiences in the continuity clinic setting. [20][21][22][23] Providers schedule most of the slots in the conventional model of scheduling (PT), placing the responsibility of scheduling under residents' and attending control. It had been assumed that opening access to patients (either in an open access or AA model) would overburden residents, decrease quality of care, and decrease both resident and patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Improving Quality and Patient Satisfaction in a Pediatric Resident Continuity Clinic Through Advanced Access Scheduling

Tuli¹,

Thompson

Ryan³

et al. 2010

Journal of Graduate Medical Education

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“…9,10 The New York experience and other published studies have led to a perception that the duty limitations have an adverse effect on continuity of care for pediatric residents. 9,11 What is the effect? Our study seeks to answer this question.…”

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confidence: 99%

Effect of 80-Hour Workweek on Continuity of Care

McBurney

Gustafson

Darden

2008

Clin Pediatr (Phila)

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Work limitations were mandated (2003) to increase safety and improve resident lifestyle. Is clinic continuity affected? Medical University of South Carolina pediatric residents' records for 6 months of 2002 (before regulation) and 2003 (after regulation) were reviewed. Continuity for physician formula, t tests, and multivariate linear regression were used. Continuity was calculated for 44 residents (2002) and 45 residents (2003). Mean continuity was 54% (2002) and 53% (2003; P = .5); continuity for well-child care visits was 78% (2002) and 73% (2003; P = .047). Continuity decreased most for interns (52% [2002], 47% [2003] for all visits; 76%, 67% for well-child care visits). In the multivariate model, year did not predict continuity. When only well-child care visits were considered, year showed a trend toward significance ( P = .07): 2003 had less continuity. Compared with third-year residents, interns had 8% points less continuity for all visits (6% points less for well-child care visits). Continuity can be maintained despite regulations. Interns are most vulnerable.

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Evening Continuity Clinic: Preserving Primary Care Education in the Face of Duty Hour Limitations?

Cited by 7 publications

References 4 publications

Organizational interventions in response to duty hour reforms

Organizational interventions in response to duty hour reforms

Improving Quality and Patient Satisfaction in a Pediatric Resident Continuity Clinic Through Advanced Access Scheduling

Effect of 80-Hour Workweek on Continuity of Care

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