Restricting resident work hours

Peets, Adam; Ayas, Najib

doi:10.1097/ccm.0b013e3182413bc5

Cited by 62 publications

(14 citation statements)

References 72 publications

(82 reference statements)

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“…The long work hours of healthcare professionals have long been a subject of debate [ 12 ]. Several studies have emphasized the degradation of performance during shift work, especially when physicians and nurses are subjected to prolonged shifts [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of chronotype on sleepiness, fatigue, and psychomotor vigilance of ICU nurses during the night shift

et al. 2015

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PurposeIn general, sleeping and activity patterns vary between individuals. This attribute, known as chronotype, may affect night shift performance. In the intensive care unit (ICR), night shift performance may impact patient safety. We have investigated the effect of chronotype and social demographics on sleepiness, fatigue, and night shift on the performance of nurses.MethodsThis was a prospective observational cohort study which assessed the performance of 96 ICU night shift nurses during the day and night shifts in a mixed medical–surgical ICU in the Netherlands. We determined chronotype and assessed sleeping behaviour for each nurse prior to starting shift work and before free days. The level of sleepiness and fatigue of nurses during the day and night shifts was determined, as was the effect of these conditions on psychomotor vigilance and mathematical problem-solving.ResultsThe majority of ICU nurses had a preference for early activity (morning chronotype). Compared to their counterparts (i.e. evening chronotypes), they were more likely to nap before commencing night shifts and more likely to have young children living at home. Despite increased sleepiness and fatigue during night shifts, no effect on psychomotor vigilance was observed during night shifts. Problem-solving accuracy remained high during night shifts, at the cost of productivity.ConclusionsMost of the ICU night shift nurses assessed here appeared to have adapted well to night shift work, despite the high percentage of morning chronotypes, possibly due to their 8-h shift duration. Parental responsibilities may, however, influence shift work tolerance.

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Section: Introductionmentioning

confidence: 99%

The effect of chronotype on sleepiness, fatigue, and psychomotor vigilance of ICU nurses during the night shift

et al. 2015

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“…This was often caused due to insufficient knowledge of residents about the significance of seemingly small details, as well as lack of tendency to consult specialists hoping to achieve independence in decision-making. It should be noted that inadequate skills and knowledge of residents, as well as their overload of patient care responsibility, could cause them to make professional errors occasionally (Naveh et al, 2015;Peets & Ayas, 2012).…”

Section: Discussionmentioning

confidence: 99%

Experiences of Obstetricians and Gynecologists in Teleconsultation with Medical Residents: A Qualitative Study

Deldar¹,

Tara²,

Mirteimouri³

et al. 2016

GJHS

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Objective: To explore the experiences of specialists, residents, and experienced personnel of obstetrics and gynecology regarding telephone consultation by specialized residents and on-call experts Design: Qualitative study based on inductive content analysis.Setting: Three departments of obstetrics and gynecology, affiliated to Mashhad University of Medical Sciences, Mashhad, Iran.Population: A purposive sample of 16 specialists, residents and experienced staff.Methods: Eighteen semi-structured interviews were conducted.Results: Analysis of interview data resulted in 363 primary codes and six main themes including: "attempt to direct the process of telephone consultation", "decision-making challenges of diagnostic-therapeutic plans for patients", "attempt to verify the acquired findings", "inefficacy in the face of life-threatening conditions", "discriminations in legal confrontation with medical errors", and "impact on emotions and personal life". Conclusions:Process of teleconsultation between physician and resident is associated with numerous challenges. Formal training sessions and considering new approaches of teleconsultation and telemedicine are needed to be implemented in order to reinforce the reliability of patient information transfer.

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“…Resident work-hour restrictions, the electronic health record (EHR) and computerized provider order entry (CPOE) have altered resident workflow. [1][2][3][4][5][6] However, the basic premise that as residents progress through their programs, they are expected to transition from collecting and conveying facts to more clinical reasoning, decision-making, and discussion of the evidence has not changed. The American Board of Internal Medicine (ABIM) has adjusted assessments of resident education to a competency-based framework and attainment of milestones for independent practice.…”

Section: Introduction Backgroundmentioning

confidence: 99%

<p>A Day in the Life of an Internal Medicine Resident – A Time Study: What Is Changed from First to Third Year?</p>

Wieler

Lehman

Khalid

et al. 2020

AMEP

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Background: In the past decade, internal medicine residencies have undergone major changes in competency-based assessments, work-hour restrictions and the implementation of the electronic medical record. The aim of this study is to compare a typical day of a first year post-graduate (PGY1) to that of a third year post-graduate (PGY3) internal medicine resident and examine if the differences in their days demonstrate the American Board of Internal Medicine's (ABIM) desired progression towards competency-based milestones and unsupervised practice. Methods: We conducted an observational time study documenting 14,103 minutes, 9 major categories, and 17 subcategories while shadowing 10 internal medicine PGY1s and 10 PGY3s during inpatient, non-call days. The following day, house staff completed surveys of their perceived time allocation of the previous 24 hours. Results: PGY1s spent an average of 12.5 hours managing an average of 6 patients. Thirtyeight percent of their time was spent on the computer, 21% discussing patients and 18% directly with patients. PGY3s, overseeing an average of 12 patients, worked 1.5 hours less per day (p<0.001), had 1.5 hours less computer time (p=0.001), 24 minutes less direct patient contact (p=0.045), and 36 minutes more patient care discussions (p=0.011). Conclusion: The difference between PGY1s' and PGY3s' daily time allocations is minimal. Whereas a PGY3 spends 1.5 hours less than a PGY1 on writing computer notes and discharges, they also work 1.5 hours less per day. The additional 36 minutes of patient care discussions was the only significant time quantity difference that would be considered a higher level of practice for the PGY3 compared to the PGY1. With residents now caring for fewer patients, there has been a marked increase in computer time per patient for both PGY1s and PGY3s.

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Restricting resident work hours

Cited by 62 publications

References 72 publications

The effect of chronotype on sleepiness, fatigue, and psychomotor vigilance of ICU nurses during the night shift

The effect of chronotype on sleepiness, fatigue, and psychomotor vigilance of ICU nurses during the night shift

Experiences of Obstetricians and Gynecologists in Teleconsultation with Medical Residents: A Qualitative Study

<p>A Day in the Life of an Internal Medicine Resident – A Time Study: What Is Changed from First to Third Year?</p>

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