Background: Overnight call is considered “home call” when residents remain at home until required for clinical duties. Unlike in-house call, ACGME does not require a post-call day for home call shifts, but we hypothesize that residents spend the majority of the night in the hospital while taking home call at busy institutions.
OBJECTIVES: This study aims to assess work requirements and impact on sleep for junior and senior residents in a level 1 trauma center when taking plastic surgery home call.
Methods: We conducted a prospective cohort study by surveying junior and senior residents who completed overnight call shifts from January – April 2023 at our level 1 trauma center. Call shifts may include: general plastics call, hand trauma, face trauma, or a combination of these. Data such as number of trips into the hospital, hours spent in the hospital, and hours of sleep were collected from residents after each call shift. Data were categorized into junior and senior levels and by call shift (ie general plastics+hand trauma+face trauma, or a combination of these.)
Results: Response rate was 195 of 200 (97.5%) total call shifts (7pm-7am). For general plastic surgery call, junior residents were called in 46.6% of overnight shifts, spending on average 0.8 hours (SD 1.27) in the hospital, and averaging 6.3 hours (SD 1.08) of sleep. For hand trauma call, they were called in 89.9% of shifts, averaging 7.07 hours (SD 4.47) in the hospital, and 3.25 hours (SD 2.10) of sleep. For face trauma call, they were called in 93.7% of shifts, averaging 6.40 hours (SD 3.76) in the hospital, and 3.92 hours (SD 2.19) of sleep. For combination call, they were called in 100% of shifts, averaging 11.3 hours (SD 2.75) in the hospital, and 0.73 (SD 1.14) hours of sleep. For general plastic surgery call, senior residents were called in 2.6% of shifts and averaged 6.34 hours (SD 1.07) of sleep. For hand trauma call, senior residents were called in 57.9% of shifts, averaging 3.7 hours (SD 4.62) in the hospital, and averaging 4.18 hours (SD 2.07) of sleep. For face trauma call, senior residents were called in 10.7% of shifts, averaging 0.32 hours (SD 1.19) in the hospital, and averaging 4.75 hours (SD 1.27) of sleep.
Conclusion: Duty requirements and hours of sleep when taking home call vary widely based on call type. Junior residents reported minimal sleep when taking hand trauma, face trauma, and triple call compared to general call. While senior residents did not physically go in to the hospital as often as junior residents, both hand and face trauma result in a statistically significant decrease in hours of sleep compared to general call. While call data will vary based on institution and speciality, a similar study should be completed for any program taking home call to ensure that residents are not violating ACGME duty hours while still maximizing their educational experience. These results highlight the need to discuss ACGME protection for residents taking “home call.”