| 574 Bed Hospital: |
with busy OB service (~5000 deliveries) |
| Resident Physicians: |
20–22 (15 OB, 3-4/mo FP, 2-3/yr FP Ob Fellows and 1 Trans/mo) |
| Problems with Previous Current Call System: |
Lack of proper coverage in day duties when post-call resident physicians had to go home; gaps in coverage on Labor & Delivery/OR services Coverage problems exacerbated when Resident physician on team was also on vacation Loss of continuity of care with service patients and lack of accountability Resident physicians too exhausted to learn on education mornings
|
| Changed to Night Float System July 1, 2010. NEW Schedule Establishes: |
Elimination of the 24 hr shift for ALL residents. Work hour shifts range from 13–16 hrs which includes patient hand-offs All residents get 1 day off/7 days NOT averaged and one 48-hr period/4 weeks NOT averaged Resident work hours do NOT exceed 80 hrs/week NOT averaged over 4 weeks 14 block rotations (including 1 vacation block – resident physicians can switch out 2 of 4 weeks with other resident physicians) Night float system will allow day and night teams to split into two 12 hour shifts with time for sign-out Resident physicians played an active role in development of work redesign
|
| Advantages to New Schedule |
Consistent full day teams with improved continuity and accountability for patient care Same teams sign out to each other five nights per week Improved education experience with resident physicians able to attend all clinics/operate on OR days because not post-call; able to follow through on care of complicated patients/pre-op and post-op care; alert and awake for educational conferences Resident physicians make their own schedules – accountable to themselves
|
| Postscript |
Dr. Domingo reports that in the seven months since implementation of the new resident schedule on July 1, 2010, more and more Ob-Gyn attending physicians are now choosing to split their 24 hour weekend call shifts into 12 hour shifts. On week days, attendings work 16 hour shifts, but many are also now switching to 12 hour shifts there as well. “It’s interesting,” says Dr. Domingo, “but I think many of us are starting to appreciate the effects of fatigue on patient safety and balance this with overall job satisfaction.”
|
