Impact of an Overnight Internal Medicine Academic Hospitalist Program on Patient Outcomes

Gonzalo, Jed D.; Kuperman, Ethan; Chuang, Cynthia H.; Lehman, Erik; Glasser, Frendy D.; Abendroth, Thomas W.

doi:10.1007/s11606-015-3389-0

Cited by 12 publications

(12 citation statements)

References 29 publications

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“…On the other hand, dual positive results, improved sleep hygiene and less medical errors, were revealed after the implementation of the EWTD Rota in Cappuccio et al 9 Discontinued patient care is considered to be emerging risk factors of communicational medical errors following the diminishment of duty hours. 23 However, O'Leary et al 17 indicates otherwise: adverse events are not associated with the handover period because patients were taken care of by medical teams and all medical actions were under the surveillance of attending physicians. On the other hand, prolonged shifts or night shifts may decrease the cognitive function of residents or affects their circadian rhythm.…”

Section: Discussionmentioning

confidence: 99%

Long Working Hour Related Medical Errors and Patient Outcomes among Physicians: A Systematic Review

Chao¹,

Chen²,

Geerdes³

et al. 2018

Emerg Med Open J

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Inspired by the famous Libby Zion case in 1984, which revealed the underlying flaw in the medical system at the time──the exploitation of junior medical staff and the inadequate surveillanceby attending physicians, authors of this systemic review aim to investigate the potential consequence of overworking in medical scenarios. Methods Excerpta medica database (EMBASE) and PubMed had been systematically searched, bibliographies of relevant studies additionally reviewed. Four cohorts and three randomized controlled trials were selected and quality-assessed with Newcastle-Ottawa Scale and the Cochrane risk of bias tool, respectively. Literature were extracted and discussed. Results Two randomized controlled trials have concluded that residents or interns with longer consecutive working hours per shift in the division of internal medicineare prone to more medical errors. One cohort study has shown a significant association between longer weekly working hours and worsened quality of patient care (intensive care unit (ICU) transfer rates and in-hospital mortality) in the setting of internal medicine. However, none of the 3 studies which were conducted in surgical departments suggests a further restriction on weekly working hours or shift length. Conclusion The specialty-specific policy is recommended based on our between-study comparison. Specifically, with respect to the incidence of medical errors or adverse events, weekly hours or shift length are weakly recommended to be regulated in the department of internal medicine, but there is no recommendation to surgical departments. However, one must consider all respects of the impact brought by any alternation of working policy before the actual implementation.

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Section: Discussionmentioning

confidence: 99%

Long Working Hour Related Medical Errors and Patient Outcomes among Physicians: A Systematic Review

Chao¹,

Chen²,

Geerdes³

et al. 2018

Emerg Med Open J

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“…1 The intervention consisted of a year-round overnight academic hospitalist program staffed by one hospitalist physician and coincided with the hours of the night float housestaff.…”

Section: T His Retrospective Interrupted Time-series Analysis Bymentioning

confidence: 99%

“…1 The intervention consisted of a year-round overnight academic hospitalist program staffed by one hospitalist physician and coincided with the hours of the night float housestaff.The study showed no significant change in their patientlevel outcomes including the average length of stay, inhospital mortality rate, 30-day readmission rate, and upgrades in care to intensive care unit.The outcomes as described above were important to evaluate in this study. However, there are likely better components for measuring whether residents and supervising hospitalists were in fact impacting the health of patients.…”

mentioning

confidence: 99%

Capsule Commentary on Gonzalo, et al., Impact of an Overnight Internal Medicine Academic Hospitalist Program on Patient Outcomes

Mathews

2015

J GEN INTERN MED

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T his retrospective, interrupted time-series analysis byGonzalo et al. evaluated the effect of an overnight academic hospitalist (OAH) program on patient-level outcomes at a large university-based acute care hospital. 1 The intervention consisted of a year-round overnight academic hospitalist program staffed by one hospitalist physician and coincided with the hours of the night float housestaff.The study showed no significant change in their patientlevel outcomes including the average length of stay, inhospital mortality rate, 30-day readmission rate, and upgrades in care to intensive care unit.The outcomes as described above were important to evaluate in this study. However, there are likely better components for measuring whether residents and supervising hospitalists were in fact impacting the health of patients. Patient-reported outcome measures (PROMs) are a helpful component of assessing whether clinicians are improving the health of patients. Unlike process measures, which capture provider productivity and adherence to the standards of recommended care, or patient experience measures, which focus on aspects of care delivery, PROMs seek to understand whether the services provided actually improved patients health and sense of well-being. 2 For example, through the implementation of an OAH program, patients might be asked to assess their general health and satisfaction in care overnight. Moreover, it would seem that not only the patient-reported outcome measures but also a learner-reported outcome measure would show promising results. In the paper by Haber et al., increased overnight supervision enhanced the clinical value of the night float rotation, increased rates of attending contact during critical clinical decision-making, and improved perception of patient care. 3 Nighttime supervision is a key concept in medical education and is critical in ensuring safe and effective patient care. 4 As noted by Hanson et al., nighttime education should be transformed in a way that maintains clinical productivity for both attending and resident physicians, integrates high-quality teaching and curricula, and achieves a balance between patient safety and resident autonomy. 5 The results of the study are promising and helpful for programs as they aim to implement systems to ensure appropriate nighttime supervision. Further study is needed to assess the impact on broader patient outcomes.

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“…Most hospitals and hospital medicine groups deploy hospitalists overnight, and nocturnists (hospitalists who primarily work night shifts) are increasingly being hired to fill this role [1]. Hospitalist/ nocturnist coverage of overnight shifts has become essential due to residency work hour limitations, increased attending-level trainee supervision requirements, and a trend toward on-site coverage of hospital wards overnight [2][3][4][5]. In one tertiary care hospital staffed exclusively by nocturnists, there was no difference in hospitalization-relevant outcomes for patients admitted overnight, compared to those admitted during the day [6].…”

Section: Introductionmentioning

confidence: 99%

The scope of hospital medicine practice at night: a national survey of night shift hospitalists

et al. 2021

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Introduction: Although in-person hospitalist presence, increasingly staffed by dedicated nocturnists, has become the norm overnight in the hospital, the scope of nocturnist practice and typical workload has not been defined. This study examines the clinical responsibilities and patient safety perceptions of hospitalists who work night shifts in the United States. Methods: In the fall of 2019, a cross-sectional, webbased survey was administered to physician and nurse practitioner/physician assistant (NP/PA) hospitalists who work night shifts. The questionnaire assessed night staffing structure, typical responsibilities, patient volume, perceptions of safety overnight, as well as demographic information. The survey was posted on the Society of Hospital Medicine (SHM) Hospital Medicine Exchange (HMX) Online Discussion Forum. Additionally, the survey was distributed by 'snowball method' by respondents to other night hospitalists. Responses were collected anonymously. Results: Of the 167 respondents, 157 reported working night shifts. There was at least one respondent from 32 different states. In addition to performing admissions to medicine services and covering inpatients, night hospitalists cover ICU patients, participate in RRT/Code teams and procedure teams, perform consults, participate in medical education, and take outpatient calls. Across institutions, there was a large distribution in numbers of patients covered in a night shift; however, patient volume fell into typical ranges: 5-10 admissions for physicians, 0-6 admissions for NP/PAs, and 25-75 patient crosscoverage census. When physicians perform more than five admissions per night, hospitalists were less likely to agree that they could provide safe care (88% vs. 63%, p = 0.0006). Conclusions: This is the first national study to examine the clinical responsibilities of hospitalists working overnight. Overnight responsibilities are heterogeneous across institutions. As hospitals are increasingly employing nocturnists, more research is needed to guide night staffing and optimize patient safety.

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Impact of an Overnight Internal Medicine Academic Hospitalist Program on Patient Outcomes

Cited by 12 publications

References 29 publications

Long Working Hour Related Medical Errors and Patient Outcomes among Physicians: A Systematic Review

Long Working Hour Related Medical Errors and Patient Outcomes among Physicians: A Systematic Review

Capsule Commentary on Gonzalo, et al., Impact of an Overnight Internal Medicine Academic Hospitalist Program on Patient Outcomes

The scope of hospital medicine practice at night: a national survey of night shift hospitalists

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