Assessing the Impact of a Change to the Work Schedule of Resident Physicians: a Mixed Methods Study

Not Applicable

• Conditions: Patient Safety; Resident Work Hours
• Interventions: Behavioral: Intervention work shift

• Registration Number: NCT01398878
• Lead Sponsor: University of British Columbia

Brief Summary

The purpose of this study is to determine the impact of eliminating traditional resident work shifts (i.e. greater than 24 hours in length) on patient safety and resident educational outcomes. In addition, the investigators will explore with key stakeholders (patients and their families, nurses, resident physicians and attending physicians) their experiences when residents are undertaking shifts greater than 24 hours in length as compared to 16 hours or less.

Detailed Description

Not available

Study Timeline

• Status Verified: 2011-07
• Study Start: 2011-07
• Study First Submitted: 2011-07-11
• Study First Submitted QC: 2011-07-19
• Study First Posted: 2011-07-21
• Last Update Submitted: 2011-07-22
• Last Update Posted: 2011-07-25
• Primary Completion: 2012-06
• Study Completion: 2012-06

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 80

Inclusion Criteria

• Residents completing Intensive Care Unit rotations
• For focus groups and interviews, patients and families members admitted during the study period and nurses and attending physicians working during the study period

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Exclusion Criteria

• None

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention work schedule	Intervention work shift	Residents in the Intensive Care Unit perform shifts less than 16 hours in length and have at least 8 hours off between shifts

Primary Outcome Measures

Name	Time	Method
Preventable adverse events	Occurring during course of ICU admission and within first 72 hours of ICU discharge if event is attributable to process of care in the ICU	The primary outcome is the rate of preventable adverse events per 1000 patient days. An adverse event will be defined as any unplanned injury arising as a consequence of medical care that is associated with morbidity, requires treatment, prolongs hospital stay, or results in disability at discharge. Adverse events are not caused by the disease process itself, but do include any procedural or therapeutic complications. Preventable adverse events will be defined as those adverse events that could have been avoided given current knowledge and standards of care.

Secondary Outcome Measures

Name	Time	Method
Quantity of scheduled and unscheduled learning activities residents participate in	End of each 28 day rotation	Assessed by review of sleep/activity log
Resident leisure time, sleep, and time spent in the hospital	End of each 28 day rotation	Assessed by review of sleep/activity log
Professionalism	End of each 28 day rotation	In order to further explore this qualitative outcome measure, during structured interviews of residents, attending physicians, nurses and patients and their families, specific questions will be used to probe the perceived level of resident professionalism. For example, degree of commitment and professional investment in individual patients, and degree of commitment to the profession of medicine.
Nursing impact	Over course of study (12 months)	In order to further explore this qualitative outcome measure, during focus groups with nurses specific questions will be used to probe the perceived level of impact on nursing.
Attending physician workload	Over course of study (12 months)	In order to further explore this qualitative outcome measure, during structured interviews of attending physicians specific questions will be used to probe the perceived level of physician workload. For example, the difference in level of direct involvement in patient care activities (writing notes, performing procedures, etc) between the two schedules.
Perceived continuity of care	Over course of study (12 months)	In order to further explore this qualitative outcome measure, during structured interviews of residents, attending physicians, nurses and patients and their families, specific questions will be used to probe the perceived level of continuity of care.
Quality of life	End of each 28 day rotation	In order to further explore this qualitative outcome measure, during structured interviews of residents specific questions will be used to probe the perceived level of quality of life for the different call schedules.
Resident knowledge acquisition and retention	End of each 28 day rotation	Scores on validated multiple choice question exams
Patient satisfaction	Within two weeks of ICU discharge	Given the multitude of potential variables that impact patient satisfaction, during the interviews of patients and their families, the following questions will be used to inform the outcome measure: a global assessment of the patient's experience, their satisfaction with the overall care provided by the healthcare team and their satisfaction with their experiences with resident physicians in particular.
Job satisfaction/Stress	End of each 28 day rotation	In order to further explore this qualitative outcome measure, during structured interviews of residents specific questions will be used to probe the perceived level of job satisfaction and stress for the different call schedules.

Trial Locations

Locations (1)

St Paul's Hospital; 🇨🇦 Vancouver, British Columbia, Canada