On-site Night Float by Attending Physicians: A Model to Improve Resident Education and Patient Care

DeFilippis, Andrew P.; Téllez, Ildefonso; Winawer, Neil H.; Francesco, Lorenzo Di; Manning, Kimberly D.; Kripalani, Sunil

doi:10.4300/jgme-d-09-00073.1

Cited by 17 publications

(17 citation statements)

References 13 publications

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“…In 2010, Defilippis et al reported a high level of resident satisfaction regarding patient care when an attending was present in the hospital for 6 hours each night. 13 Residents also felt the on-site attending was helpful with patient evaluations and developing treatment plans. Although results were not directly compared to those without attending hospitalists present, they were substantially better than historical results at the same hospital.…”

Section: Discussionmentioning

confidence: 99%

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Neurohospitalists Enhance Resident Perception of the Educational and Clinical Value of a Night Float Rotation

Greene

2013

The Neurohospitalist

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Background and Purpose: Neurology residency training programs have been profoundly impacted by recent changes in resident duty hours, workloads, and supervisory requirements. In response, many programs have adopted a night float coverage system to minimize the requirements for overnight call. The majority involves residents working a block of night shifts in what is typically a service-oriented rotation. Recently, concerns have arisen regarding the impact of this design on resident education and patient care. We have developed a novel on-site nighttime neurohospitalist model for the explicit purpose of steepening the initial learning curve for neurology residents in an effort to rapidly improve their neurological skills and, in conjunction, overnight patient care. We surveyed residents after the initiation of this system to assess their perception of the impact of direct overnight supervision on education and patient care. Methods: As part of ongoing quality improvement efforts, surveys were administered to neurology house staff at a tertiary academic medical center after they had completed service on the night float rotation both with and without an attending in the hospital using a retrospective pre/postdesign. Results: There was a robust positive impact on resident's perception of overall quality, educational value, and clinical quality on the night float rotation with an attending onsite. Despite an overall perception that their autonomy was maintained, residents believed barriers to contact the attending were lower, and attending interaction during critical decision making was more frequent. Conclusions: Direct overnight supervision by a neurohospitalist enhances the educational value and care quality on overnight resident rotations.Keywords residency, education, night float, supervision, autonomy, neurohospitalist, quality Residency training programs have been profoundly impacted by restrictions on resident duty hours, workloads, and supervisory requirements implemented by the Accreditation Council for Graduate Medical Education over the past decade, and neurology residencies are no exception. In response, many programs have undergone substantial changes in design and schedule; most have adopted a night float coverage system to minimize requirements for overnight call and comply with duty hour restrictions. Although there are a variety of models in practice, the majority involves residents working a block of night shifts to cover consultations, admissions, and urgent issues for established inpatients. 1-4Night float is typically a service-oriented rotation with selfguided learning being the norm and opportunities for attending interaction and patient follow-up limited to phone contact. Although these systems decrease continuous and total work hours for residents, concerns have been raised regarding their impact on resident education and the quality of patient care delivered. 5-11Since more stringent duty hour restrictions for interns (postgraduate year 1 [PGY-1]) were enacted in 2010, firstyear neu...

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Section: Discussionmentioning

confidence: 99%

“…Additionally, a positive attitude and perception of value are thought to be very important for learning, and these were clearly improved by direct supervision overnight. [11][12][13]15 Figure 1. Neurology resident perceptions of educational and clinical value of night float rotation are improved by an on-site neurohospitalist.…”

Section: Discussionmentioning

confidence: 99%

Neurohospitalists Enhance Resident Perception of the Educational and Clinical Value of a Night Float Rotation

Greene

2013

The Neurohospitalist

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“…In contrast to night medicine, interns on night float rotations typically have little faculty interaction, leading to fewer opportunities for bedside teaching and observation of direct patient care. [2][3][4] Multiple studies have highlighted residents' perceptions of night float rotations as predominantly service-focused time with few formal educational opportunities. [4][5][6][7] While night float rotations have been valued for their experiential learning potential, they have historically lacked a formalized educational component.…”

Section: Introductionmentioning

confidence: 99%

“…9 Challenges inherent in night float rotations include cross-coverage responsibilities and resident fatigue, leading to decreased alertness. 10 Two studies 2,3 showed perceived improvements in the value of care delivered and in resident education with the presence of dedicated, on-site, attending physicians. Critics, however, argue that this structure has a negative effect on resident autonomy overnight, decreasing the experiential learning component of such rotations that is felt to be so valuable to the professional maturation of resident physicians.…”

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confidence: 99%

Implementation of a Novel, Resident-Led, Nocturnal Curriculum

Golbus

Manly

Wonneberger

et al. 2015

Journal of Graduate Medical Education

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“…4 In response, various medical and surgical specialties have developed duty hour compliance systems without substantial ill effect on surgical case volume or other educational outcomes. 5,6 To meet the 2011 ACGME standards, the Oregon Health & Science University (OHSU) neurological surgery residency program instituted a novel 3-person night float system in January 2011. 2 Here we describe the planning and implementation of this new system and analyze resident duty hour violations, number of operative cases logged, and resident acceptance of duty hour regulations for 12 months before and 12 months after institution of the new system.…”

Section: Introductionmentioning

confidence: 99%

An ACGME Duty Hour Compliant 3-Person Night Float System for Neurological Surgery Residency Programs

Ragel¹,

Piedra²,

Klimo³

et al. 2014

Journal of Graduate Medical Education

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Background In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted the 24+6-hour work schedule and 80-hour workweek, and in 2011, it enhanced work hour and supervision standards. Innovation In response, Oregon Health & Science University's (OHSU) neurological surgery residency instituted a 3-person night float system. Methods We analyzed work hour records and operative experience for 1 year before and after night float implementation in a model that shortened a combined introductory research and basic clinical neurosciences rotation from 12 to 6 months. We analyzed residents' perception of the system using a confidential survey. The ACGME 2011 work hour standards were applied to both time periods. Results After night float implementation, the number of duty hour violations was reduced: 28-hour shift (11 versus 235), 8 hours off between shifts (2 versus 20), 80 hours per week (0 versus 17), and total violations (23 versus 275). Violations increased only for the less than 4 days off per 4-week interval rule (10 versus 3). No meaningful difference was seen in the number of operative cases performed per year at any postgraduate year (PGY) training level: PGY-2 (336 versus 351), PGY-3 (394 versus 354), PGY-4 (803 versus 802), PGY-5 (1075 versus 1040), PGY-7 (947 versus 913), and total (3555 versus 3460). Residents rated the new system favorably. Conclusions To meet 2011 ACGME duty hour standards, the OHSU neurological surgery residency instituted a 3-person night float system. A nearly complete elimination of work hour violations did not affect overall resident operative experience.

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On-site Night Float by Attending Physicians: A Model to Improve Resident Education and Patient Care

Abstract: A night-float system that includes on-site attending physician supervision can provide a valuable opportunity for resident education and may help improve the quality of patient care.

Cited by 17 publications

References 13 publications

Neurohospitalists Enhance Resident Perception of the Educational and Clinical Value of a Night Float Rotation

Neurohospitalists Enhance Resident Perception of the Educational and Clinical Value of a Night Float Rotation

Implementation of a Novel, Resident-Led, Nocturnal Curriculum

An ACGME Duty Hour Compliant 3-Person Night Float System for Neurological Surgery Residency Programs

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