Strategies to Accommodate Resident Work-Hour Restrictions: Impact on Surgical Education

Freiburg, Carter; James, Ted A.; Ashikaga, Takamura; Moalem, Jacob; Cherr, Greg

doi:10.1016/j.jsurg.2011.03.011

Cited by 21 publications

(15 citation statements)

References 17 publications

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“…2,3,14,15,21,23,27,30,31 It is important that we critically examine the effect that these changes have on the hospital work environment, and most importantly on patient care, before advocating widespread adoption.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, patients and other health care workers report high satisfaction rates. 4,7,8,23,[26][27][28][29][30] Significant reductions in hospital and intensive care unit LOS have been reported after the addition of PEs to surgical or trauma services. [7][8][9][10][11][12][13][14] Morbidity and mortality remain stable, and some studies have shown a reduction of in-hospital complication rates.…”

Section: Discussionmentioning

confidence: 99%

“…Nine articles examined satisfaction rates of surgeons, residents and nursing staff and found overall high satisfaction rates. 4,7,8,23,[26][27][28][29][30] Improvements to patient care, continuity of care, communication with families, improved clinical docu mentation and reduced workload for other health care workers were all reported as reasons for the high satisfaction rates.…”

Section: Satisfactionmentioning

confidence: 99%

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Physician extenders on surgical services: a systematic review

Johal

Dodd

2017

CJS

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Background: With the introduction of resident duty hour restrictions and the resulting in-house trainee shortages, a long-term solution to ensure safe and efficient patient care is needed. One solution is the integration of nurse practitioners (NPs) and physician assistants (PAs) in a variety of health care settings. We sought to examine the use of NPs and PAs on surgical/trauma services and their effect on patient outcomes and resident workload. Methods:We performed a systematic review of EMBASE, Medline, CINAHL, and the Cochrane Central Register of Controlled Trials. We included studies (all designs) examining the use of NPs and PAs on adult surgical and trauma services that reported the following outcomes: complications, length of stay, readmission rates, patient satisfaction and perceived quality of care, resident workload, resident work hours, resident sleep hours, resident satisfaction, resident perceived quality of care, other health care worker satisfaction and perceived quality of care, and economic impact assessments. We excluded studies assessing nonsurgical/trauma services or pediatrics and review articles.Results: Twenty-nine articles met the inclusion criteria. With the addition of NPs and PAs, patient length of stay decreased, and morbidity and mortality were unchanged. In addition, resident workload decreased, sleep time increased, and operating time improved. Patient and health care worker satisfaction rates were high. Several studies reported cost savings after the addition of NPs/PAs. Conclusion:The addition of NPs and PAs to surgical/trauma services appears to be a safe, cost-effective method to manage some of the challenges arising because of resident duty hour restrictions. More high-quality research is needed to confirm these findings and to further assess the economic impact of adding NPs and PAs to the surgical team.Contexte : Compte tenu de la réduction du nombre d'heures de travail des médecins résidents et de la pénurie de stagiaires qui en a résulté, une solution à long terme s'impose pour assurer la sécurité et l'efficacité des soins aux patients. Une solution consiste à intégrer des infirmières praticiennes (IP) et des adjoints aux médecins (AM) dans divers contextes de soins de santé. Nous avons voulu examiner l'incidence du recours aux IP et aux AM dans des services de chirurgie et de traumatologie et son effet sur la santé des patients et sur la charge de travail des médecins résidents.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Satisfactionmentioning

confidence: 99%

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Physician extenders on surgical services: a systematic review

Johal

Dodd

2017

CJS

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“…The most frequently substituted labor by departments was mid-level providers rather than neurohospitalists or other neurologists, consistent with the experience in pediatrics. 20 Mid-level providers have frequently been cited as a means to replace lost resident labor, 20,[21][22][23][24][25] which may cost hospitals nearly twice that of resident physicians. 8,10,11 Although the clinical value of residents compared to midlevel providers remains unknown in neurology, comparisons in emergency medicine and primary care suggest similar clinical value.…”

Section: Discussionmentioning

confidence: 99%

Impact of 2011 Resident Duty Hour Requirements on Neurology Residency Programs and Departments

George

Probasco

Dorsey

et al. 2014

The Neurohospitalist

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Objective: In 2011, the Accreditation Council on Graduate Medical Education (ACGME) redefined resident duty hour requirements by reducing in-hospital duty hour requirements for residents in an effort to improve patient care, resident wellbeing, and resident education. We sought to determine the cost of adoption based on changes made by neurology residency programs and departments due to these requirements. Methods: We surveyed department chairs or residency program directors at 123 ACGME-accredited US adult neurology training programs on programmatic changes and resident expansion, hiring practices, and development of new computer-based resources in direct response to the 2011 ACGME duty hour requirements. Using data from publicly available resources, we estimated respondents' financial cost of adoption. Results: In all, 63 responded (51% response rate); 76% were program directors. The most common changes implemented by programs were adding night float systems (n ¼ 31; 49%) and increasing faculty responsibility (n ¼ 26; 41%). In direct response to the requirements, 21 programs applied to ACGME for 40 additional residents, 29 of which were fully covered by institutional funds. In direct response to the requirements, nearly half of the departments (n ¼ 26) hired individuals for a total of 80 hires (or 64 full-time equivalents), most commonly mid-level practitioners. The total estimated cost to responding departments was US $12.7 million or US $201,000 per department annually. When projecting expenses of planned changes for the following year, costs increased to US $360,000 per department, with 5-year costs exceeding US $1 million. Conclusions: The most recent restriction on resident duty hours comes at substantial cost to neurology departments and residency programs.

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“…Sin embargo, los residentes, los profesores y las instituciones educativas enfrentan restricción en las horas asistenciales para los residentes, lo cual exige un verdadero compromiso por parte de los docentes y los estudiantes de posgrado. Dado lo anterior, es fundamental maximizar la experiencia educativa mediante la educación basada en estas seis competencias, con herramientas específicas que las incorporen de manera didáctica al proceso de formación 3,6 . ¿Debe existir una rotación formal en cirugía laparoscópica?…”

Section: Cambio De La Filosofía De La Educación Quirúrgicaunclassified