Table 1.

Innovation case study – internal medicine

Summa Health System (affiliate of North East Ohio University College of Medicine), Akron, OH.
Program Director – David B. Sweet, MD (sweetd@summa-health.org).
563 Bed Hospital:	100–120 Medicine residency beds
Resident Physicians:	68–45 IM Categorical + 6 IM Prelim PGY 1 + 10 Trans Yr Prelim PGY 1 + 7 FTE Rotators. [IM = Internal Medicine; PGY = Postgraduate Year; FTE = full time employee]
Schedule:	< 2004 – traditional 24 + 6 call > 2006 – 80% 12–13 hour calls / 20% 16 hour calls with Saturday cross-coverage to preserve 1 free “golden weekend” per month.
Impetus for Change:	Consistently over hours limits; literature supported reduced hours; support from ACGME Educational Innovation Project.
Obstacles to Implementation:	Inertia (fear of change / it can’t be done).
Cost:	No hiring of additional personnel; 3 elective months lost in 3 yrs; re-schedule continuity clinic on post-admitting days.
Secrets to Success:	Involve resident physicians and study work flow; minimize change for PGY 3s; create schedule to allow a buffer time to finish care tasks; expect to revise the schedule in the second year; use quality (education and continuity of care) metrics; promote more organized handovers.
Outcome:	Found that rested resident physicians read more, attended more didactic sessions; 7 of 16 June 2010 graduates presented research at national or international meetings.