Pediatric residents' perceptions of the impact of the 24-hour on-call system on their well-being and education and patient safety. A national survey

An analysis of the 24-hour on-call experience and treatment decision of a dental resident, a retrospective study

Objectives

To analyze the 24-hour on-call experience and factors influencing the treatment decisions of a dental resident for dental emergencies, particularly pulpitis, during on-call hours.

Methods

This retrospective study was conducted at a public stomatology hospital from January 1 to December 30, 2023. Each consultation was documented, recording the date and time, patient age and gender, diagnosis, and any emergent interventions. Statistical analyses were conducted using univariate analysis to explore the association between various factors and the incidence of dental interventions for pulpitis, with significance set at p < 0.05.

Results

Over 1 year, 81 residents from seven specialties managed 2,717 consultations during 365 instances of 24-h call duty. The busiest months were October (n = 297). Most consultations occurred during extended hours (1,856 consultations) compared to normal hours (8:00-17:00) (861 consultations). The busiest consultation periods were between 20:00 and 22:00. Pulpitis was the most frequently diagnosed condition (n = 988). Univariate analysis showed no significant impact of patient gender (p = 0.896) or age (p = 0.632) on the likelihood of receiving a dental intervention. However, consultations during extended hours were twice as likely (OR = 2.028, 95% CI [1.510-2.723]) to result in no intervention compared to normal hours. Endodontics and pediatric dentistry residents were more likely to perform interventions compared to other specialties, with postgraduate year (PGY) six residents being less likely to perform interventions compared to PGY4 residents.

Conclusion

Residents exhibit lower willingness to perform dental interventions during extended working hours and in higher grade levels, with significant variability across different specialties. Enhanced training and fatigue risk management for residents may help to ensure effective patient care during on-call hours.

Medication Error During the Day and Night Shift on Weekdays and Weekends: A Single Teaching Hospital Experience in Riyadh, Saudi Arabia

Background

The association between medication error incidence and time (day shift vs night shift) have not been extensively studied in Saudi Arabia, this study aimed to answer this question: is there a relationship between medication error incidence and time of the day (day shifts vs night shifts) on weekdays and weekends?.

Objective

To identify whether medication errors and their sub-categories are significantly different between day shifts, night shifts, during weekdays and weekends.

Methods

A retrospective analysis of medication errors reported by health-care practitioners from January 2018 to December 2019 through the Electronic-Occurrence Variance Reporting System (E-OVR) of a university teaching hospital in Riyadh, Saudi Arabia. Statistical analysis was used to determine the differences between the medication errors and their sub-categories and day and night shifts during weekdays (from Sunday to Thursday) and weekends (Friday and Saturday).

Results

A total of 2626 medication errors were reported over 2 years from January 2018 to December 2019. The most prevalent sub-category of medication errors was prescribing errors (55%), while the least common sub-category of medication errors was administration errors (0.6%). There was a statistically significant difference between medication errors and day of the week. Medication errors that happened on weekdays were greater than at weekends (P = 0.01). During weekends, medication errors were more likely to occur at the night shift compared to the day shift (P < 0.05).

Conclusion

Timing of medication errors incidence is an important factor to be considered for improving the medication use process and improving patient safety. Further researches are needed that focus on intervention to reduce these errors, especially during night shifts.

Pediatric resident's perception of night float system compared to 24 hours system, a prospective study

BACKGROUND

The study aims to evaluate the perceptions of pediatric residents under the night float (NF) on-call system and its impact on well-being, education, and patient safety compared with the traditional 24-h on-call system.

METHODS

The study is prospective in nature and conducted on two pediatric resident training centers who apply the NF on-call system as a pilot project. Senior residents (PGY-3 and PGY-4) enrolled in the two training centers were invited to participate before and 6 months after the implementation of the change in the on-call system. A self-administered online questionnaire was distributed. Responses were rated using a five-point Likert-type scale (1 = strongly disagree; 5 = strongly agree). The items covered three main domains, namely, residents' well-being, ability to deliver healthcare, and medical education experience. Pre- and post-intervention scores were presented as means and compared by t-test for paired samples.

RESULTS

A total of 42 residents participated in the survey (female = 24; 57.1%). All participants were senior residents; 25 (59.6%) were third-year residents (PGY-3), whereas 17 (40.4%) were fourth-year residents (PGY-4). The participants reported that many aspects of the three domains were improved with the introduction of the NF system. The system was perceived to exert less adverse health effect on the residents (mean: 2.37 ± 1.01) compared with the 24-h on-call system (mean: 4.19 ± 0.60; P < 0.001). In addition, the NF system was perceived to lead to less exposure to personal harm and result in less negative impact on quality of care, better work efficiency, reduced potential for medical errors, more successful teaching, and less disruptions to other rotations compared with the 24 h on-call system (P < 0.001).

CONCLUSION

The perception of senior residents toward the 24-h on-call system pertains to negative impacts on well-being, education, and patient safety compared with on-call systems with restrictive duty hours, such as the NF system, which is perceived to be less harmful, to exert positive impacts on the quality of delivered healthcare services, and more useful from pedagogic aspect.