Restructuring an Inpatient Resident Service to Improve Outcomes for Residents, Students, and Patients

被引:22
作者
O'Connor, Alec B. [1 ]
Lang, Valerie J.
Bordley, Donald R. [1 ]
机构
[1] Univ Rochester, Sch Med & Dent, Internal Med Residency Program, Rochester, NY 14642 USA
关键词
INTERNAL-MEDICINE; DUTY HOURS; SIGN-OUT; WORK; EDUCATION; IMPACT; CARE; DISCONTINUITY; SATISFACTION; ASSOCIATION;
D O I
10.1097/ACM.0b013e3182359491
中图分类号
G40 [教育学];
学科分类号
040101 ; 120403 ;
摘要
Purpose This study assesses the effects of a resident teaching service restructuring on resident, student, and patient outcomes. Method Interventions included eliminating a "day float" admitting team, converting one-resident: one-intern teams to one-resident: two-intern teams, reducing patient caps from 11 to 7 patients per intern, and increasing pairing between resident teams and attendings. Resident end-of-rotation evaluations and time spent in categorized activities; student end-of-clerkship evaluations, patient logs, and subject exam scores; and hospital-collected patient outcome data were compared before (2007-2008) versus after (2008-2009) the changes. Results Interns covered fewer patients per day post intervention (9.9 apiece to 6.3 apiece), whereas the total number of patients covered increased (2,501 to 2,916). Enjoyment of the rotation was higher post intervention for interns and senior residents. Residents' time in direct patient care activities and with interns increased post intervention, but residents spent less time with medical students. Students' ratings of several aspects of the clerkship were significantly higher in the postintervention year. Students evaluated more previously unevaluated patients post intervention (32.6% to 45.8%, P < .001), but subject exam scores were unchanged. The median length of stay decreased post intervention (5.0 to 4.0 days, P = .02), and fewer patients required ICU care (11.2% to 7.9%, P < .001). These differences persisted after adjusting for multiple covariates. Conclusions An intervention that reduced handoffs and intern patient census and that increased hospitalist pairing was associated with improved resident and student experiences, a favorable impact on patient outcomes, and probable cost savings.
引用
收藏
页码:1500 / 1507
页数:8
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