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Coombs A. Researchers revolt against weekend conferences. Nature 2023; 623:1093-1094. [PMID: 37914874 DOI: 10.1038/d41586-023-03430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
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2
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George N. A Glimpse Into the Magnet® Program Office: The High-Performing Senior Magnet® Program Analyst Team. J Nurs Adm 2021; 51:302-303. [PMID: 34006800 DOI: 10.1097/nna.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Magnet Recognition Program® has a dedicated team of RNs and non-RNs who are committed to advancing nursing and supporting healthcare organizations on their Magnet® journeys. Healthcare organizations who are either Magnet-designated or applicants for Magnet designation regularly communicate with the various members of the Magnet program office team. This perspective will highlight the roles of the senior Magnet program analysts and the assistant director of Magnet program operations.
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Affiliation(s)
- Nicole George
- Author Affiliation : Assistant Director, Magnet Program Operations, Silver Spring, MD
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3
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Abstract
This study examines the hours worked and patterns of work activities before and during the COVID-19 pandemic among US physicians.
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Affiliation(s)
- Xiaochu Hu
- Association of American Medical Colleges, Washington, DC
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4
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Abstract
This literature review aims to provide an account of the changes to orthopaedics in the era of COVID-19. Herein, the authors explored the use of telemedicine in orthopaedics as well as changes in surgical protocols, screening methods, work priorities and orthopaedic education. There was increased utilisation of telemedicine in orthopaedic training and outpatient cases as a means to provide continuity in education and care. The need to implement social distancing measures, coupled with the reduced availability of staff, has dictated that the practice of orthopaedics shifts to focus on acute care whilst redistributing resources to front-line specialities. This was facilitated by the cancellation of electives and the reduction of outpatient clinics. Thus, it is demonstrated that major changes have been implemented in many aspects of orthopaedic practice in order to address the challenges of the COVID-19 pandemic.
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Affiliation(s)
- Ali Al-kulabi
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Azeem Thahir
- Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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White EM, Shaughnessy MP, Esposito AC, Slade MD, Korah M, Yoo PS. Surgical Education in the Time of COVID: Understanding the Early Response of Surgical Training Programs to the Novel Coronavirus Pandemic. J Surg Educ 2021; 78:412-421. [PMID: 32768380 PMCID: PMC7381939 DOI: 10.1016/j.jsurg.2020.07.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/21/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Describe the early impact of the COVID-19 pandemic on general surgery residency training nationwide. DESIGN A 31-question electronic survey was distributed to general surgery program directors. Qualitative data underwent iterative coding analysis. Quantitative data were evaluated with summary statistics and bivariate analyses. PARTICIPANTS Eighty-four residency programs (33.6% response rate) with representation across US geographic regions, program affiliations, and sizes. RESULTS Widespread changes were observed in the surgical training environment. One hundred percent of programs reduced the number of residents on rounds and 95.2% reduced the size of their in-hospital resident workforce; on average, daytime staffing decreased by nearly half. With telehealth clinics (90.5%) and remote inpatient consults (26.2%), both clinical care and resident didactics (86.9%) were increasingly virtual, with similar impact across all program demographics. Conversely, availability of some wellness initiatives was significantly higher among university programs than independent programs, including childcare (51.2% vs 6.7%), housing (41.9% vs 13.3%), and virtual mental health services (83.7% vs 53.3%). CONCLUSIONS Changes in clinical care delivery dramatically reduced in face-to-face learning opportunities for surgical trainees during the COVID-19 pandemic. While this effect had equal impact across all program types, sizes, and geographies, the same cannot be said for wellness initiatives. Though all programs initiated some strategies to protect resident health, the disparity between university programs and independent programs may be cause for action.
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Affiliation(s)
- Erin M White
- Department of Surgery, Yale University, New Haven, Connecticut
| | | | | | - Martin D Slade
- Occupational Health & Environmental Medicine, Yale University, New Haven, Connecticut
| | - Maria Korah
- School of Medicine, Yale University, New Haven, Connecticut; Department of Surgery, Stanford University, Stanford, California
| | - Peter S Yoo
- Department of Surgery, Yale University, New Haven, Connecticut.
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Cohen JL, Dayan SH, Avram MM, Saltz R, Kilmer S, Maas CS, Schlessinger J. Aesthetic Office Disaster Preparedness and Response Plan. J Drugs Dermatol 2021; 20:10-16. [PMID: 33400419 DOI: 10.36849/jdd.5803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The coronavirus pandemic (COVID-19) has served as a call-to-arms in preparing practices for the next disaster whether it is another infectious disease or a flood, hurricane, earthquake, a sustained power outage, or something else. A group of predominantly core aesthetic physicians discussed the various aspects of their office procedures that warrant consideration in a proactive approach to the next pandemic/disaster-related event. This guide does not set a standard of practice but contains recommendations that may avoid some of the "lessons learned" with the COVID-19 pandemic. In this paper, the board-certified core aesthetic physicians classified these recommendations into four generalized areas: Practice Management; Supplies and Inventory; Office Staffing Considerations and Protocols; and Patient Management Strategies. Proactive strategies are provided in each of these categories that, if implemented, may alleviate the processes involved with an efficient office closure and reopening process including, in the case of COVID-19, methods to reduce the risk of transmission to doctors, staff, and patients. These strategies also include being prepared for emergency-related notifications of employees and patients; the acquisition of necessary equipment and supplies such as personal protective equipment; and the maintenance and accessibility of essential data and contact information for patients, vendors, financial advisors, and other pertinent entities.J Drugs Dermatol. 2021;20(1):10-16. doi:10.36849/JDD.5803.
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Hu X, Liu S, Wang B, Xiong H, Wang P. Management practices of emergency departments in general hospitals based on blockage of chain of infection during a COVID-19 epidemic. Intern Emerg Med 2020; 15:1545-1552. [PMID: 32948990 PMCID: PMC7500495 DOI: 10.1007/s11739-020-02499-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/05/2020] [Indexed: 10/29/2022]
Abstract
In a Coronavirus disease 2019 (COVID-19) epidemic, management of the emergency department is a difficult task in terms of prevention and control of the disease in general hospitals. On top of meeting urgent needs of patients for medical treatment, the emergency department also has to devote resources into investigation and prevention of COVID-19. At the beginning of the epidemic, with the strategy to intercept the chain of infection, Peking University First Hospital (PKUFH) focused on three important aspects: controlling the source of infection, cutting off the route of transmission, and protecting vulnerable populations, to expeditiously draft scientific and proper management measures for the emergency department, followed by real-time dynamic adjustments based on the development trend of the epidemic. These measures effectively ensured a smooth, orderly and safe operation of the emergency department. As of the writing of this manuscript, there has been no active COVID-19 infection in patients and medical staff in the emergency department, and no infection in patients admitted to PKUFH through the emergency department. This study describes the prevention and control measures in the emergency department of PKUFH during the outbreak of COVID-19, aiming to provide some reference for domestic and international medical institutions.
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Affiliation(s)
- Xiaojing Hu
- grid.411472.50000 0004 1764 1621Medical Affairs Department, Peking University First Hospital, Beijing, China
| | - Si Liu
- grid.411472.50000 0004 1764 1621Medical Affairs Department, Peking University First Hospital, Beijing, China
| | - Bo Wang
- grid.411472.50000 0004 1764 1621Emergency Department, Peking University First Hospital, Beijing, China
| | - Hui Xiong
- grid.411472.50000 0004 1764 1621Emergency Department, Peking University First Hospital, Beijing, China
| | - Ping Wang
- grid.411472.50000 0004 1764 1621Medical Affairs Department, Peking University First Hospital, Beijing, China
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Jarvis S, Orlando A, Blondeau B, Banton K, Reynolds C, Berg GM, Patel N, Meinig R, Carrick M, Bar-Or D. The effect of orthopaedic surgeons' and interventional radiologists' availability on the priority treatment sequence for hemodynamically unstable pelvic fractures: a survey of US Level I trauma centers. J Orthop Surg Res 2019; 14:411. [PMID: 31801568 PMCID: PMC6894122 DOI: 10.1186/s13018-019-1417-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/15/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Most guidelines recommend both pelvic packing (PP) and angioembolization for hemodynamically unstable pelvic fractures, however their sequence varies. Some argue to use PP first because orthopaedic surgeons are more available than interventional radiologists; however, there is no data confirming this. METHODS This cross-sectional survey of 158 trauma medical directors at US Level I trauma centers collected the availability of orthopaedic surgeons and interventional radiologists, the number of orthopaedic trauma surgeons trained to manage pelvic fractures, and priority treatment sequence for hemodynamically unstable pelvic fractures. The study objective was to compare the availability of orthopaedic surgeons to interventional radiologists and describe how the availability of orthopaedic surgeons and interventional radiologists affects the treatment sequence for hemodynamically unstable pelvic fractures. Fisher's exact, chi-squared, and Kruskal-Wallis tests were used, alpha = 0.05. RESULTS The response rate was 25% (40/158). Orthopaedic surgeons (86%) were on-site more often than interventional radiologists (54%), p = 0.003. Orthopaedic surgeons were faster to arrive 39% of the time, and interventional radiologists were faster to arrive 6% of the time. There was a higher proportion of participants who prioritized PP before angioembolization at centers with above the average number (> 3) of orthopaedic trauma surgeons trained to manage pelvic fractures, as among centers with equal to or below average, p = 0.02. Arrival times for orthopaedic surgeons did not significantly predict prioritization of angioembolization or PP. CONCLUSIONS Our results provide evidence that orthopaedic surgeons typically are more available than interventional radiologists but contrary to anecdotal evidence most participants used angioembolization first. Familiarity with the availability of orthopaedic surgeons and interventional radiologists may contribute to individual trauma center's treatment sequence.
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Affiliation(s)
- S. Jarvis
- Clinical Epidemiologist, ION Research, 383 Corona St. #319, Denver, CO 80218 USA
| | - A. Orlando
- Clinical Epidemiologist, ION Research, 383 Corona St. #319, Denver, CO 80218 USA
| | - B. Blondeau
- Research Medical Center, 2316 East Meyer Blvd., Kansas City, MO 64132 USA
- University of Connecticut Hartford Hospital, Hartford, CT 06106 USA
| | - K. Banton
- Swedish Medical Center, 501 E Hampden Ave., Englewood, CO 80113 USA
| | - C. Reynolds
- Swedish Medical Center, 501 E Hampden Ave., Englewood, CO 80113 USA
| | - G. M. Berg
- Wesley Medical Center, 550 N. Hillside St., Wichita, KS 67214 USA
| | - N. Patel
- Orthopaedic Trauma Surgeon, St. Anthony’s Hospital, 11600 West 2nd Place, Lakewood, CO 80228 USA
| | - R. Meinig
- Orthopaedic Trauma Surgeon, Penrose Hospital, 2222 North Nevada Ave., Colorado Springs, CO 80907 USA
| | - M. Carrick
- Medical City Plano, 3901 West 15th Street, Plano, TX 75075 USA
| | - D. Bar-Or
- Swedish Medical Center, 501 E Hampden Ave., Englewood, CO 80113 USA
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Park S, Lebovitz L, Pincus KJ. Addressing preceptor shortages with a novel structure of blended ambulatory care rotations. Curr Pharm Teach Learn 2019; 11:1248-1253. [PMID: 31836149 DOI: 10.1016/j.cptl.2019.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/29/2019] [Accepted: 09/07/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Schools of pharmacy are challenged to ensure sufficient full-time ambulatory care advance pharmacy practice experiences (APPEs). University of Maryland designed an innovative solution to create additional rotations utilizing faculty with part-time ambulatory care practices, by combining two rotation blocks into a 10-week "blended" ambulatory care/community pharmacy experience. The objective of this study is to characterize perceptions and impact of this format on student and preceptor skills, performance, and overall satisfaction, compared with the traditional five-week ambulatory care rotation. METHODS Ambulatory care preceptors were surveyed regarding student skills in interviewing, documentation, patient assessment, building pharmacist-patient relationships, and mentorship opportunities. Students were surveyed regarding the number of preceptors and patient interactions/week, rotation hours, clinical abilities developed, patient relationships, patient population diversity, preceptor mentorship, clinical track participation, rotation expectations, professional benefit, career development, overall satisfaction, and likelihood to recommend the rotation. Chi-square test was used to evaluate statistically significant differences in cohort responses. RESULTS Survey responses from 74 students (49%) and 21 preceptors (46%) were included. Student perceptions were generally positive and comparable between groups. Statistically significant differences were observed between groups in students' perception of "patient diversity" and preceptors' perception of "patient-pharmacist relationship". CONCLUSION The 10-week blended format provides a unique and viable option that offers a solution to shortages of preceptor availability for ambulatory care APPEs by providing a rotation format that is more conducive to clinical practice faculty part-time ambulatory clinic schedules.
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Affiliation(s)
- Soeun Park
- University of Maryland School of Pharmacy, 20 N Pine Street, Baltimore, MD 21201, United States.
| | - Lisa Lebovitz
- University of Maryland School of Pharmacy, 20 N Pine Street, Room S303, Baltimore, MD 21201, United States.
| | - Kathleen J Pincus
- University of Maryland School of Pharmacy, Department of Pharmacy Practice and Sciences, 20 N Pine Street, Room N425, Baltimore, MD 21201, United States.
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Taran S, Chin-Yee B, Detsky AS. Night Call in a Teaching Hospital: 1979 and 2019. J Hosp Med 2019; 14:782-784. [PMID: 31433766 DOI: 10.12788/jhm.3284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
No matter the era, few aspects of residency are more
defining or memorable than overnight call. Nights
can be a time of growth and learning but also of
fear and uncertainty, as residents take on the responsibility
of managing sick patients on their own. One of
us (ASD) started his residency in 1978 at the Massachusetts
General Hospital in Boston; the other two (ST and BCY) started
theirs in 2016 and 2017, respectively, at the University of
Toronto. In this essay, we reflect on our experiences of night
call separated by 40 years, highlighting what has changed and
what has stayed the same.
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Affiliation(s)
- Shaurya Taran
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Chin-Yee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allan S Detsky
- Institute for Health Policy, Management, and Evaluation, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
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Hanson C, Singh S, Zamboni K, Tyagi M, Chamarty S, Shukla R, Schellenberg J. Care practices and neonatal survival in 52 neonatal intensive care units in Telangana and Andhra Pradesh, India: A cross-sectional study. PLoS Med 2019; 16:e1002860. [PMID: 31335869 PMCID: PMC6650044 DOI: 10.1371/journal.pmed.1002860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Indian government supports both public- and private-sector provision of hospital care for neonates: neonatal intensive care is offered in public facilities alongside a rising number of private-for-profit providers. However, there are few published reports about mortality levels and care practices in these facilities. We aimed to assess care practices, causes of admission, and outcomes from neonatal intensive care units (NICUs) in public secondary and private tertiary hospitals and both public and private medical colleges enrolled in a quality improvement collaborative in Telangana and Andhra Pradesh-2 Indian states with a respective population of 35 and 50 million. METHODS AND FINDINGS We conducted a cross-sectional study between 30 May and 26 August 2016 as part of a baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges) offering neonatal intensive care. We assessed the availability of staff and services, adherence to evidence-based practices at admission, and case fatality after admission to the NICU using a range of tools, including facility assessment, observations of admission, and abstraction of registers and telephone interviews after discharge. Our analysis is adjusted for clustering and weighted for caseload at the hospital level and presents findings stratified by type and ownership of hospitals. In total, the NICUs included just over 3,000 admissions per month. Staffing and infrastructure provision were largely according to government guidelines, except that only a mean of 1 but not the recommended 4 paediatricians were working in public secondary NICUs per 10 beds. On admission, all neonates admitted to private hospitals had auscultation (100%, 19 of 19 observations) but only 42% (95% confidence interval [CI] 25%-62%, p-value for difference is 0.361) in public secondary hospitals. The most common single cause of admission was preterm birth (25%) followed by jaundice (23%). Case-fatality rates at age 28 days after admission to a NICU were 4% (95% CI 2%-8%), 15% (9%-24%), 4% (2%-8%) and 2% (1%-5%) (Chi-squared p = 0.001) in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, respectively, according to facility registers. Case fatality according to postdischarge telephone interviews found rates of 12% (95% CI 7%-18%) for public secondary hospitals. Roughly 6% of admitted neonates were referred to another facility. Outcome data were missing for 27% and 8% of admissions to private tertiary hospitals and private medical colleges. Our study faced the limitation of missing data due to incomplete documentation. Further generalizability was limited due to the small sample size among private facilities. CONCLUSIONS Our findings suggest differences in quality of neonatal intensive care and 28-day survival between the different types of hospitals, although comparison of outcomes is complicated by differences in the case mix and referral practices between hospitals. Uniform reporting of outcomes and risk factors across the private and public sectors is required to assess the benefits for the population of mixed-care provision.
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Affiliation(s)
- Claudia Hanson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Samiksha Singh
- Public Health Foundation, India, Kavuri Hills, Madhapur, Hyderabad, India
| | - Karen Zamboni
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| | - Mukta Tyagi
- Public Health Foundation, India, Kavuri Hills, Madhapur, Hyderabad, India
| | - Swecha Chamarty
- Public Health Foundation, India, Kavuri Hills, Madhapur, Hyderabad, India
| | - Rajan Shukla
- Public Health Foundation, India, Kavuri Hills, Madhapur, Hyderabad, India
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
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Abstract
AIM This commentary advocates a research agenda for studying how alternative work arrangements (AWAs) affect nurse management and leadership. BACKGROUND AWAs mitigate burnout and the distributional imbalance of nurses. However, scholarship has shed limited light on how AWAs shape nurses' workplace communication and relationships. EVALUATION Peer-reviewed nursing and management scholarship. KEY ISSUE As healthcare systems in many countries move toward team-based care, communication becomes even more important for effective coordination and collaboration among healthcare team members. CONCLUSION Researchers should invest greater resources to understand the influence that AWAs have on different organizational settings as well as on the relational coordination among nurses and their managers. IMPLICATIONS FOR NURSING MANAGEMENT Because care delivery and workplace relations depend heavily upon effective collaboration, researchers must update scholarship on AWAs to inform nurses and their managers on how they may strategically and effectively adapt their communication to evolving work environments that undergo frequent changes in nursing staff and teams.
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Affiliation(s)
- Ivan Gan
- Department of Arts and Communication, University of Houston-Downtown, Houston, Texas
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Abstract
Current public sector austerity measures necessitate efficiency savings throughout the NHS. Performance targets have resulted in activity being performed in the private sector, waiting list initiative lists and requests for staff to work overtime. This has resulted in staff fatigue and additional agency costs. Adoption of extended operating theatre times (0800-1800 hours) may improve productivity and efficiency, with potentially significant financial savings; however, implementation may adversely affect staff morale and patient compliance. A pilot period of four months of extended operating times (4.5 hour sessions) was completed and included all theatre surgical specialties. Outcome measures included: the number of cases completed, late starts, early finishes, cancelled operations, theatre overruns, preoperative assessment and 18-week targets. The outcomes were then compared to pre-existing normal working day operating lists (0900-1700). Theatre staff, patient and surgical trainee satisfaction with the system were also considered by use of an anonymous questionnaire. The study showed that in-session utilisation time was unchanged by extended operating hours 88.7% (vs 89.2%). The service was rated as 'good' or 'excellent' by 87.5% of patients. Over £345,000 was saved by reducing premium payments. Savings of £225,000 were made by reducing privately outsourced operation and a further £63,000 by reviewing staff hours. Day case procedures increased from 2.8 to 3.2 cases/day with extended operating. There was no significant increase in late starts (5.1% vs 6.8%) or cancellation rates (0.75% vs 1.02%). Theatre over-runs reduced from 5% to 3.4%. The 18 weeks target for surgery was achieved in 93.7% of cases (vs 88.3%). The number of elective procedures increased from 4.1 to 4.89 cases/day. Only 13.33% of trainees (n = 33) surveyed felt that extended operating had a negative impact on training. The study concludes that extended operating increased productivity from 2.8 patients per session to 3.2 patients per session with potential savings of just over £2.4 million per financial year. Extrapolating this to the other 155 trusts in England could be a potential saving of £372 million per year. Staff, trainee and patient satisfaction was unaffected. An improved 18 weeks target position was achieved with a significant reduction in private sector work. However, some staff had difficulty with arranging childcare and taking public transport and this may prevent full implementation.
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Abstract
Introduction Integrating work and home domains is a constant challenge for medical professionals. Only half of physicians report positive work-life satisfaction, implying that negotiating the inherent conflicts between work and home may not be intuitive. Early teaching of skills focused on professional sustainability may best prepare physicians to navigate conflicts between work and home domains. Methods This interactive workshop targets trainees and junior faculty. It aims to highlight the current state of physician career satisfaction, to bring awareness to the risk of physician burnout, and to apply strategies that promote work-life integration as a lifelong practice for sustained career satisfaction. It includes a detailed presentation with structured resources to reinforce skill development. Results This workshop was delivered five times to trainees and junior faculty. Workshop evaluations (n = 50) revealed that all participants believed the information presented was useful, addressed competencies relevant to their training, and increased their knowledge about how to create better work-life integration; all anticipated improvement in their professional work. They all recommended this program to a colleague. Discussion This workshop offers an effective way to teach a skill set that enhances physicians' abilities to negotiate conflicting work and life domain boundaries. Our results indicate that learners intend to apply newly acquired strategies for work-life integration so as to improve career satisfaction and wellness. Such skill sets may mitigate physician burnout and promote career sustainability, both critical issues with far-reaching implications for the delivery of safe, high-quality health care at the provider and system levels.
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Affiliation(s)
- Cory Pitre
- Assistant Professor, Department of Emergency Medicine, Indiana University School of Medicine
- Transitional Year Residency Program Director, Indiana University School of Medicine
| | - Lauren Ladd
- Assistant Professor, Department of Radiology and Imaging Sciences, Indiana University School of Medicine
- Transitional Year Residency Associate Program Director, Indiana University School of Medicine
| | - Julie Welch
- Associate Professor, Department of Emergency Medicine, Indiana University School of Medicine
- Director of Mentoring, Indiana Clinical and Translational Sciences Institute
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Murphy JFA. Residents Rosters: Reversal to Longer Hours in the US. Ir Med J 2017; 110:595. [PMID: 29341507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- J F A Murphy
- Holles Street National Maternity Hospital, Holles Street, Dublin 2, Ireland
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17
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Helfrich CD, Simonetti JA, Clinton WL, Wood GB, Taylor L, Schectman G, Stark R, Rubenstein LV, Fihn SD, Nelson KM. The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members. J Gen Intern Med 2017; 32:760-766. [PMID: 28233221 PMCID: PMC5481228 DOI: 10.1007/s11606-017-4011-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/11/2017] [Accepted: 02/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians. OBJECTIVE To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams. DESIGN We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014. PARTICIPANTS Primary care personnel at VA clinics responding to a national survey. MAIN MEASURES Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity). KEY RESULTS There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition. CONCLUSIONS Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.
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Affiliation(s)
- Christian D. Helfrich
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA USA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA USA
| | - Joseph A. Simonetti
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Walter L. Clinton
- Office of Analytics and Business Intelligence, US Department of Veterans Affairs, Seattle, WA USA
| | - Gordon B. Wood
- Office of Analytics and Business Intelligence, US Department of Veterans Affairs, Seattle, WA USA
| | - Leslie Taylor
- Office of Analytics and Business Intelligence, US Department of Veterans Affairs, Seattle, WA USA
| | | | - Richard Stark
- VA Office of Clinical Operations, Washington, DC USA
| | - Lisa V. Rubenstein
- Center for the Study of Healthcare Innovation, Implementation, & Policy, Greater Los Angeles VA, Sepulveda, CA USA
- UCLA School of Medicine, Los Angeles, CA USA
- RAND Corp, Santa Monica, CA USA
| | - Stephan D. Fihn
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
- Office of Analytics and Business Intelligence, US Department of Veterans Affairs, Seattle, WA USA
| | - Karin M. Nelson
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
- Office of Analytics and Business Intelligence, US Department of Veterans Affairs, Seattle, WA USA
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Pfander VA, Breznau A. Ensuring the Future of Perianesthesia Staffing: A Perianesthesia Nurse Residency Program. J Perianesth Nurs 2017; 33:518-526. [PMID: 30077296 DOI: 10.1016/j.jopan.2016.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/20/2016] [Indexed: 11/28/2022]
Abstract
Recruitment and retention of nurses into the perianesthesia environment remains an ongoing challenge in the face of a national nursing shortage. An insufficient supply of experienced critical care nurses exists to fulfill the staffing needs of perianesthesia departments. Literature describes the impact of successful orientation programs on retention and employee engagement. To compensate for the diminished candidate pool and to improve retention, a nurse residency program was created. The program develops non-critical care experienced nurses into postanesthesia care unit-specific critical care nurses over the course of 1 year. Eight months after implementation, the vacancy rate decreased to 0%. This article details the development and implementation of a perianesthesia nurse residency program.
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Neuburger J, Currie C, Wakeman R, Johansen A, Tsang C, Plant F, Wilson H, Cromwell DA, van der Meulen J, De Stavola B. Increased orthogeriatrician involvement in hip fracture care and its impact on mortality in England. Age Ageing 2017; 46:187-192. [PMID: 27915229 DOI: 10.1093/ageing/afw201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Indexed: 01/08/2023] Open
Abstract
Objectives to describe the increase in orthogeriatrician involvement in hip fracture care in England and its association with improvements in time to surgery and mortality. Study design analysis of Hospital Episode Statistics for 196,401 patients presenting with hip fracture to 150 hospitals in England between 1 April 2010 and 28 February 2014, combined with data on orthogeriatrician hours from a national organisational survey. Methods we examined changes in the average number of hours worked by orthogeriatricians in orthopaedic departments per patient with hip fracture, and their potential effect on mortality within 30 days of presentation. The role of prompt surgery (on day of or day after presentation) was explored as a potential confounding factor. Associations were assessed using conditional Poisson regression models with adjustment for patients' sex, age and comorbidity and year, with hospitals treated as fixed effects. Results between 2010 and 2013, there was an increase of 2.5 hours per patient in the median number of hours worked by orthogeriatricians-from 1.5 to 4.0 hours. An increase of 2.5 hours per patient was associated with a relative reduction in mortality of 3.4% (95% confidence interval 0.9% to 5.9%, P = 0.01). This corresponds to an absolute reduction of approximately 0.3%. Higher numbers of orthogeriatrician hours were associated with higher rates of prompt surgery, but were independently associated with lower mortality. Conclusion in the context of initiatives to improve hip fracture care, we identified statistically significant and robust associations between increased orthogeriatrician hours per patient and reduced 30-day mortality.
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Affiliation(s)
- Jenny Neuburger
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, 34-43 Lincoln's Inn Fields, London WC2A 3PE, UK
- Nuffield Trust-Research, London W1G 7LP, UK
| | - Colin Currie
- Formerly of Geriatric Medicine Unit, School of Clinical Sciences and Community Health, College of Medicine and Veterinary Medicine, Edinburgh University, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Robert Wakeman
- Basildon & Thurrock University Hospitals NHS Foundation Trust, Nethermayne, Basildon, Essex, SS16 5NL, UK
| | - Antony Johansen
- Trauma Unit, Cardiff and Vale NHS Trust, Cardiff CF14 4XW, UK
| | - Carmen Tsang
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, 34-43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - Fay Plant
- Springcare Ltd., Beech House, Wollerton, Shropshire TF9 3NB, UK
| | - Helen Wilson
- Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK
| | - David A Cromwell
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, 34-43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Bianca De Stavola
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Li S, Pittman P, Han X, Lowe TJ. Nurse-Related Clinical Nonlicensed Personnel in U.S. Hospitals and Their Relationship with Nurse Staffing Levels. Health Serv Res 2017; 52 Suppl 1:422-436. [PMID: 28127771 PMCID: PMC5269549 DOI: 10.1111/1475-6773.12655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study examines nurse-related clinical nonlicensed personnel (CNLP) in U.S. hospitals between 2010 and 2014, including job categories, trends in staffing levels, and the possible relationship of substitution between this group of workers and registered nurses (RNs) and/or licensed practical nurses (LPNs). DATA SOURCE We used 5 years of data (2010-2014) from an operational database maintained by Premier, Inc. that tracks labor hours, hospital units, and facility characteristics. STUDY DESIGN We assessed changes over time in the average number of total hours worked by RNs, LPNs, and CNLP, adjusted by total patient days. We then conducted linear regressions to estimate the relationships between nurse and CNLP staffing, controlling for patient acuity, volume, and hospital fixed effects. PRINCIPAL FINDINGS The overall use of CNLP and LPN hours per patient day declined from 2010 to 2014, while RN hours per patient day remained stable. We found no evidence of substitution between CNLP and nurses during the study period: Nurse-related CNLP hours were positively associated with RN hours and not significantly related to LPN hours, holding other factors constant. CONCLUSIONS Findings point to the importance of examining where and why CNLP hours per patient day have declined and to understanding of the effects of these changes on outcomes.
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Affiliation(s)
- Suhui Li
- Mathematica Policy Research Inc, Princeton, NJ
| | - Patricia Pittman
- George Washington University, the Milken Institute of Public Health, and the Health Workforce Institute, Washington, DC
| | - Xinxin Han
- George Washington University, the Milken Institute of Public Health, and the Health Workforce Institute, Washington, DC
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Ray A, Jones D, Palamara K, Overland M, Steinberg KP. Improving Ambulatory Training in Internal Medicine: X + Y (or Why Not?). J Gen Intern Med 2016; 31:1519-1522. [PMID: 27439977 PMCID: PMC5130949 DOI: 10.1007/s11606-016-3808-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/01/2016] [Accepted: 06/29/2016] [Indexed: 11/27/2022]
Abstract
The Accreditation Council for Graduate Medical Education (ACGME) requirement that internal medicine residents spend one-third of their training in an ambulatory setting has resulted in programmatic innovation across the country. The traditional weekly half-day clinic model has lost ground to the block or "X + Y" clinic model, which has gained in popularity for many reasons. Several disadvantages of the block model have been reported, however, and residency programs are caught between the threat of old and new challenges. We offer the perspectives of three large residency programs (University of Washington, Emory University, and Massachusetts General Hospital) that have successfully navigated scheduling challenges in our individual settings without implementing the block model. By sharing our innovative non-block models, we hope to demonstrate that programs can and should create the solution that fits their individual needs.
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Affiliation(s)
- Alaka Ray
- Massachusetts General Hospital/Harvard Medical School, 15 Parkman Street, Wang 635, Boston, MA, 02114, USA.
| | | | - Kerri Palamara
- Massachusetts General Hospital/Harvard Medical School, 15 Parkman Street, Wang 635, Boston, MA, 02114, USA
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Abstract
This paper examines the effects of ownership conversions on hospital performance between 1987 and 1998 in areas of financial performance, staffing, capacity, and unprofitable care. Conversions to government and for-profit ownership both increased the profit margin: the former due to rising revenue, and the latter due to reduced operating costs and rising revenue. Hospitals that converted to for-profit ownership had the greatest reduction in staffing relative to other converted hospitals. There was little change in bed capacity after conversion to for-profit status, but some reductions in bed capacity after conversion to government or nonprofit status. No conversion of any kind led to a reduced amount of unprofitable care, but conversion to private ownership (nonprofit and for-profit) increased the probability of trauma center closures.
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Affiliation(s)
- Yu-Chu Shen
- Health Policy Center, Urban Institute, Washington DC 20037, USA.
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Brand E, Fridberg M, Knudsen UK, Barfod KW. Noticeable Variations in the Educational Exposure During Residency in Danish Orthopedic Departments. J Surg Educ 2016; 73:1014-1019. [PMID: 27397415 DOI: 10.1016/j.jsurg.2016.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/27/2016] [Accepted: 04/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of the study was to examine the educational exposure during residency in Danish orthopedic departments. DESIGN Questionnaire-based cross-sectional study. SETTING Data were gathered from January 1, 2014 to April 30, 2014 through a nationwide web-based questionnaire containing 15 questions within the areas of workload, surgical procedures, outpatient clinic, and research activities. The residents targeted worked at small-to-large hospitals and in tertiary care centers. PARTICIPANTS Every resident in Denmark (n = 163) with at least 3 active months at a department was included. Questionnaires with less than 80% completion were excluded. In total, 152 entries were registered. Among those, 27 did not meet the inclusion criteria and 29 were excluded, leaving 96 participants, representing 22 of 26 departments, for further analysis. RESULTS The average number of operative procedures as primary surgeon was 16 (range: 8-35) per month. In all, 18 of 22 (81%) departments offered the possibility to participate in research facilitated by the department and 38 of 96 (40%) worked for free (an average of 10h a month [range: 3-60]) to increase the amount of surgical procedures. CONCLUSIONS A large variation in the educational exposure was found among the Danish orthopedic departments. Numbers indicate that Danish residents, compared with their US counterparts, operate considerably less during residency. Most residents work overtime and many of them work for free to participate in more surgical procedures.
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Affiliation(s)
- Eske Brand
- Department of Orthopaedic Surgery, Copenhagen University Hospital Holbaek, Holbaek, Denmark.
| | - Marie Fridberg
- Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev, Herlev, Denmark
| | | | - Kristoffer Weisskirchner Barfod
- Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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RN workforce update: Current and long-range forecast. Nurs Manag (Harrow) 2016; 47:1. [PMID: 27787396 DOI: 10.1097/01.NUMA.0000508237.72125.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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25
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Laier J. Nurse Staffing - A Look at Where We've Been. Ohio Nurses Rev 2016; 91:6-7. [PMID: 30561944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Mirmehdi I, O'Neal CM, Moon D, MacNew H, Senkowski C. The Interventional Arm of the Flexibility In Duty-Hour Requirements for Surgical Trainees Trial: First-Year Data Show Superior Quality In-Training Initiative Outcomes. J Surg Educ 2016; 73:e131-e135. [PMID: 27651054 DOI: 10.1016/j.jsurg.2016.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/11/2016] [Accepted: 07/26/2016] [Indexed: 05/16/2023]
Abstract
PURPOSE With the implementation of strict 80-hour work week in general surgery training, serious questions have been raised concerning the quality of surgical education and the ability of newly trained general surgeons to independently operate. Programs that were randomized to the interventional arm of the Flexibility In duty-hour Requirements for Surgical Trainees (FIRST) Trial were able to decrease transitions and allow for better continuity by virtue of less constraints on duty-hour rules. Using National Surgical Quality Improvement Program Quality In-Training Initiative data along with duty-hour violations compared with old rules, it was hypothesized that quality of care would be improved and outcomes would be equivalent or better than the traditional duty-hour rules. It was also hypothesized that resident perception of compliance with duty hour would not change with implementation of new regulations based on FIRST trial. METHODS Flexible work hours were implemented on July 1, 2014. National Surgical Quality Improvement Program Quality In-Training Initiative information was reviewed from July 2014 to January 2015. Patient risk factors and outcomes were compared between institutional resident cases and the national cohort for comparison. Residents' duty-hour logs and violations during this period were compared to the 6-month period before the implementation of the FIRST trial. The annual Accreditation Council for Graduate Medical Education resident survey was used to assess the residents' perception of compliance with duty hours. RESULTS With respect to the postoperative complications, the only statistically significant measures were higher prevalence of pneumonia (3.4% vs. 1.5%, p < 0.05) and lower prevalence of sepsis (0% vs. 1.5%, p < 0.05) among cases covered by residents with flexible duty hours. All other measures of postoperative surgical complications showed no difference. The total number of duty-hour violations decreased from 54 to 16. Had the institution not been part of the interventional arm of the FIRST trial, this number would have increased to 238. The residents' perception of compliance with 80-hour work week from the Accreditation Council for Graduate Medical Education survey improved from 68% to 91%. CONCLUSIONS Residents with flexible work hours on the interventional arm of the FIRST trial at our institution took care of a significantly sicker cohort of patients as compared with the national dataset with equivalent outcomes. Flexible duty-hour policy under the FIRST trial has enabled the residents to have fewer work-hour violations while improving continuity of care to the patients. Additionally, the overall perception of resident compliance with the duty-hour requirements was improved.
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Affiliation(s)
- Issa Mirmehdi
- Department of Surgery, Mercer University School of Medicine, Memorial University Medical Center, Savannah, Georgia.
| | - Cindy-Marie O'Neal
- Department of Surgery, Mercer University School of Medicine, Memorial University Medical Center, Savannah, Georgia
| | - Davis Moon
- Department of Surgery, Mercer University School of Medicine, Memorial University Medical Center, Savannah, Georgia
| | - Heather MacNew
- Department of Surgery, Mercer University School of Medicine, Memorial University Medical Center, Savannah, Georgia
| | - Christopher Senkowski
- Department of Surgery, Mercer University School of Medicine, Memorial University Medical Center, Savannah, Georgia
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Affiliation(s)
- Sean P Clarke
- Sean P. Clarke is a professor and associate dean of undergraduate programs at the Boston (Mass.) College William F. Connell School of Nursing and a Nursing Management editorial board member
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What is the proper compensation plan for a physician who wants to implement a 'job share' model? MGMA Connex 2016; 16:45-6. [PMID: 30375778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Merrifield N. NHS nurse staffing problems 'will continue for next few years'. Nurs Times 2016; 112:3. [PMID: 27337775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Cozad MJ, Lindley LC, Mixer SJ. Staff Efficiency Trends Among Pediatric Hospices, 2002-2011. Nurs Econ 2016; 34:82-89. [PMID: 27265950 PMCID: PMC5045247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study provided the first examination of staff efficiency trends among pediatric hospices. Although pediatric staff efficiency demonstrated large variability from 2002 to 2011, the general trend in efficiency from 2003 to 2010. The decline in efficiency means, on average, pediatric hospices had higher operating expenses and used more capacity, but greater amounts of these greater outputs as measured by visits per patient. The study also highlights the crucial role pediatric hospice nurse managers play in developing effective workforce strategies that allow for responsive changes to workload fluctuations. Due to the associations between efficiency, regulation, and growth, nurse leaders' abilities to develop effective strategies are more imperative than ever to ensure quality end-of-life care for children and their families.
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Chilver K. Seven-day NHS will only lead to more reliance on agency staff. Nurs Stand 2015; 30:31. [PMID: 26329081 DOI: 10.7748/ns.30.1.31.s40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Saver C. Staffing at most ASCs stays stable despite recruitment challenges. OR Manager 2015; 31:25-26. [PMID: 26477215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Stephenson J. Reliance on temporary nursing staff remains largely unchecked. Nurs Times 2015; 111:4. [PMID: 26182593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Ball J. Staffing plans are all well and good, but we need to heed alarm bells too. Nurs Stand 2015; 29:34. [PMID: 25902243 DOI: 10.7748/ns.29.34.34.s41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Kleebauer A. Parties court votes with promises on staff numbers, patients and NHS. Nurs Stand 2015; 29:14-15. [PMID: 25902220 DOI: 10.7748/ns.29.34.14.s19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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37
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Lauriello J. 21st century training in psychosis. Acad Psychiatry 2015; 39:151-153. [PMID: 25722121 DOI: 10.1007/s40596-015-0294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/23/2015] [Indexed: 06/04/2023]
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38
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Moy C. No quick fix for Texas' shortage of psychiatrists. Tex Med 2015; 111:13-15. [PMID: 25856851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Louwrens NA. In reference to "front-line ordering clinicians: matching workforce to workload". J Hosp Med 2015; 10:67. [PMID: 25418422 DOI: 10.1002/jhm.2287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/03/2014] [Accepted: 10/28/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Neil A Louwrens
- Department of Internal Medicine, Mercy Medical Center, Redding, California
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40
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Fieldston E. In response to "front-line ordering clinicians: matching workforce to workload". J Hosp Med 2015; 10:68. [PMID: 25418336 DOI: 10.1002/jhm.2286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Evan Fieldston
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Hanna J, Gutteridge D, Kudithipudi V. Finding the elusive balance between reducing fatigue and enhancing education: perspectives from American residents. BMC Med Educ 2014; 14 Suppl 1:S11. [PMID: 25560226 PMCID: PMC4304265 DOI: 10.1186/1472-6920-14-s1-s11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Duty hour restrictions for residency training were implemented in the United States to improve residents' educational experience and quality of life, as well as to improve patient care and safety; however, these restrictions are by no means problem-free. In this paper, we discuss the positive and negative aspects of duty hour restrictions, briefly highlighting research on the impact of reduced duty hours and the experiences of American residents. We also consider whether certain specialties (e.g., Emergency Medicine, Radiology) may be more amenable than others (e.g., Surgery) to duty hour restrictions. We conclude that feedback from residents is a crucial element that must be considered in any future attempts to strike a balance between reducing fatigue and enhancing education.
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Affiliation(s)
- John Hanna
- Radiology Department, McLaren Flint/ Michigan State University, Flint, Michigan, USA
| | - Daniel Gutteridge
- Internal Medicine Department, Division of Pulmonary and Critical Care, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Venu Kudithipudi
- Radiology Department, Duke University, Durham, North Carolina, USA
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Abstract
The working hours of junior doctors have been a focus of discussion in Australia since the mid-1990s. Several national organizations, including the Australian Medical Association (AMA), have been prominent in advancing this agenda and have collected data (most of which is self-reported) on the working hours of junior doctors over the last 15 years. Overall, the available data indicate that working hours have fallen in a step-wise fashion, and AMA data suggest that the proportion of doctors at high risk of fatigue may be declining. It is likely that these changes reflect significant growth in the number of medical graduates, more detailed specifications regarding working hours in industrial agreements, and a greater focus on achieving a healthy work-life balance. It is notable that reductions in junior doctors' working hours have occurred despite the absence of a national regulatory framework for working hours. Informed by a growing international literature on working hours and their relation to patient and practitioner safety, accreditation bodies such as the Australian Commission on Safety and Quality in Health Care (ACSQHC) and the Australian Medical Council (AMC) are adjusting their standards to encourage improved work and training practices.
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Affiliation(s)
- Nicholas J Glasgow
- Medical School, Australian National University, Canberra ACT 0200, Australia
| | - Michael Bonning
- Past Chair, Australian Medical Association, Council of Doctors-in-Training, Barton ACT 2604, Australia
| | - Rob Mitchell
- Past Chair, Australian Medical Association, Council of Doctors-in-Training, Barton ACT 2604, Australia
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Jamal MH, Wong S, Whalen TV. Effects of the reduction of surgical residents' work hours and implications for surgical residency programs: a narrative review. BMC Med Educ 2014; 14 Suppl 1:S14. [PMID: 25560685 PMCID: PMC4304271 DOI: 10.1186/1472-6920-14-s1-s14] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The widespread implementation of resident work hour restrictions has led to significant alterations in surgical training and the postgraduate educational experience. We evaluated the experience of surgical residency programs as reflected in the literature from 2008 onward in order to summarize current challenges and identify key areas in need of further research. METHODS We searched MEDLINE and EMBASE for English-language articles published from January 2008 to December 2011 related to work hour restrictions in surgical residency programs, including those pertaining to personal well-being, education and training, patient care, and faculty experiences. RESULTS We retrieved 240 unique abstracts and included 24 studies in the current review. Of the 10 studies examining effects on operating room experience, 4 reported negative or mixed outcomes and 6 reported neutral outcomes, although non-compliance was demonstrated in 2 of these studies. Effects on surgical faculty perceptions were consistently reported as negative, while the effect on patient outcomes and professionalism were found to be neutral and unchanged. CONCLUSIONS Further studies are needed to characterize operative experience at varying levels of training, particularly in the context of strict adherence to new work hours. Research that examines the effect of the work hour limitations on professionalism and non-operative educational activities, such as reading and simulation-based training, as well as sign-over practices, would also be of benefit.
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Affiliation(s)
- Mohammad H Jamal
- Department of General Surgery, McGill University Health Centre, Montreal, Canada
- Department of Surgery, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Stephanie Wong
- Department of General Surgery, McGill University Health Centre, Montreal, Canada
| | - Thomas V Whalen
- Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
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Abstract
Safe and appropriate health care, especially in urgent or emergency situations, is the expectation of the public throughout the developed world. Achieving this goal requires appropriate levels of medical and other staff, appropriate training, and sensible working hours. Too often the brunt of such care, especially in out-of-hours situations, is borne by medical residents, who--to make matters worse--are frequently poorly supervised by more senior and experienced staff. Many jurisdictions have been alerted to this problem and are striving to correct it. However, the variation in attempts to restrict the actual hours worked by residents to "safe" levels is enormous, and all too often there is no consensus as to what should be put in place to achieve safe patient care. This paper sets out the current position for Europe, North America, and Australia.
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Affiliation(s)
- John Temple
- Research Council, The Healing Foundation, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, UK
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45
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Abstract
The medical establishment is grappling with the complex issue of duty hour regulations - an issue that is a natural consequence of the numerous changes in medical culture and practice that have occurred over the course of decades. Sleep deprivation resulting from long duty hours has a recognized impact on resident health and wellness. This paper will briefly outline the evolution of the concept of well-being in residency, review the specific theme of fatigue management within that context, and describe strategies that may be used to mitigate and manage fatigue, as well as approaches that may be taken to adapt to new scheduling models such as night float. Finally, the paper will call for a change in the culture in our workplaces and among our residents and faculty to one that promotes good health and ensures that we maintain a fit and sustainable medical workforce.
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46
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Abstract
Understanding medical professionalism and its evaluation is essential to ensuring that physicians graduate with the requisite knowledge and skills in this domain. It is important to consider the context in which behaviours occur, along with tensions between competing values and the individual’s approach to resolving such conflicts. However, too much emphasis on behaviours can be misleading, as they may not reflect underlying attitudes or professionalism in general. The same behaviour can be viewed and evaluated quite differently, depending on the situation. These concepts are explored and illustrated in this paper in the context of duty hour regulations. The regulation of duty hours creates many conflicts that must be resolved, and yet their resolution is often hidden, especially when compliance with or violation of regulations carries significant consequences. This article challenges attending physicians and the medical education community to reflect on what we value in our trainees and the attributions we make regarding their behaviours. To fully support our trainees’ development as professionals, we must create opportunities to teach them the valuable skills they will need to achieve balance in their lives. [P]rofessionalism has no meaningful existence independent of the interactions that give it form and meaning. There is great folly in thinking otherwise. Hafferty and Levinson (2008)[1] Understanding and evaluating professionalism is essential to excellence in medical education and is mandated by organizations that oversee medical training [2]. Historically, attention has been focused largely on the professionalism of individual students or residents, at least for the purposes of evaluation. Yet there is now a growing appreciation that professionalism can be defined, understood, and evaluated from multiple perspectives [3]. Importantly, context has been recognized as critical to shaping trainees’ behaviours, and hence as important to our understanding of them [4]. A restriction in duty hours for trainees is clearly an important environmental and contextual factor to consider in evaluating professional behaviour. In this paper I will review some key issues with respect to understanding and evaluating professionalism, and then discuss these in the context of duty hour reform. Readers should note that this is not intended to be a comprehensive review of the literature of either professionalism or duty hour reform, but rather a critical narrative review that uses selected articles.
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Affiliation(s)
- Shiphra Ginsburg
- Department of Medicine and Wilson Centre for Research in Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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47
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Abstract
As junior doctors work shorter hours in light of concerns about the harmful effects of fatigue on physician performance and health, it is imperative to consider how to ensure that patient safety is not compromised by breaks in the continuity of care. By reconceptualizing handover as a necessary bridge to continuity, and hence to safer patient care, the model of continuity-enhanced handovers has the potential to allay fears and improve patient care in an era of increasing fragmentation. "Continuity-enhanced handovers" differ from traditional handovers in several key aspects, including quality of information transferred, greater professional responsibility of senders and receivers, and a different philosophy of "coverage." Continuity during handovers is often achieved through scheduling and staffing to maximize the provision of care by members of the primary team who have first-hand knowledge of patients. In this way, senders and receivers often engage in intra-team handovers, which can result in the accumulation of greater common ground or shared understanding of the patients they collectively care for through a series of repeated interactions. However, because maximizing team continuity is not always possible, other strategies such as cultivating high-performance teams, making handovers active learning opportunities, and monitoring performance during handovers are also important. Medical educators and clinicians should work toward adopting and testing principles of continuity-enhanced handovers in their local practices and share successes so that innovation and learning may spread easily among institutions and practices.
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Affiliation(s)
- Vineet M Arora
- Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA
| | - Darcy A Reed
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kathlyn E Fletcher
- Department of Medicine, Milwaukee VAMC/Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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48
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Abstract
Fuelled by concerns about resident health and patient safety, there is a general trend in many jurisdictions toward limiting the maximum duration of consecutive work to between 14 and 16 hours. The goal of this article is to assist institutions and residency programs to make a smooth transition from the previous 24- to 36-hour call system to this new model. We will first give an overview of the main types of coverage systems and their relative merits when considering various aspects of patient care and resident pedagogy. We will then suggest a practical step-by-step approach to designing, implementing, and monitoring a scheduling system centred on clinical and educational needs in the context of resident duty hour reform. The importance of understanding the impetus for change and of assessing the need for overall workflow restructuring will be explored throughout this process. Finally, as a practical example, we will describe a large, university-based teaching hospital network's transition from a traditional call-based system to a novel schedule that incorporates the new 16-hour duty limit.
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Affiliation(s)
- Ning-Zi Sun
- Division of General Internal Medicine, McGill University Health Centre; Department of Medicine, McGill University, QC, Canada
| | - Thomas Maniatis
- Division of General Internal Medicine, McGill University Health Centre; Department of Medicine, McGill University, QC, Canada
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49
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Abstract
The potential impact of resident duty hour restrictions on faculty is likely significant; however, the extent of this impact has still not been well documented. We undertook a narrative review of the literature to determine the magnitude of that potential impact and the nature of the evolving discourse related to faculty members as individuals. The literature provides an inconsistent picture of the impact of duty hour restrictions on faculty. While some studies have reported a significant increase in faculty workload, others suggest that the impact of duty hour restrictions has been minimal. Some papers suggest that duty hour restrictions may fundamentally change the nature of resident-teacher interactions and, as a result, will necessitate significant changes to the way education is delivered. Overall, the majority of issues of concern relate to one of the following: volume and composition of work, impact on faculty career choice, evolving perceptions of residents as learners, and the need to find an appropriate balance between learning and the quality and quantity of patient care. In describing these themes we identify some potential solutions and future directions for reconciling duty hour restrictions with faculty perceptions, anxieties, and desired outcomes.
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MESH Headings
- Attitude of Health Personnel
- Databases, Bibliographic
- Education, Medical, Graduate/organization & administration
- Education, Medical, Graduate/standards
- Education, Medical, Graduate/trends
- Faculty, Medical/organization & administration
- Faculty, Medical/standards
- Humans
- Internship and Residency/organization & administration
- Internship and Residency/standards
- Internship and Residency/trends
- Interprofessional Relations
- Job Satisfaction
- Nurse Practitioners/statistics & numerical data
- Nurse Practitioners/trends
- Personnel Staffing and Scheduling/standards
- Personnel Staffing and Scheduling/trends
- Physician Assistants/statistics & numerical data
- Physician Assistants/trends
- Quality Assurance, Health Care/organization & administration
- Quality Assurance, Health Care/standards
- Quality Assurance, Health Care/trends
- Work Schedule Tolerance
- Workload
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Affiliation(s)
- Glen Bandiera
- University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Salvatore M Spadafora
- University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
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50
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Abstract
BACKGROUND Changes in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations. This paper examines, and assesses the impact of, organizational interventions that were a direct response to these duty hour reforms. METHODS The academic literature was searched through the SCOPUS database using the search terms "resident duty hours" and "European Working Time Directive," together with terms related to organizational factors. The search was limited to English-language literature published between January 2003 and January 2012. Studies were included if they reported an organizational intervention and measured an organizational outcome. RESULTS Twenty-five articles were included from the United States (n=18), the United Kingdom (n=5), Hong Kong (n=1), and Australia (n=1). They all described single-site projects; the majority used post-intervention surveys (n=15) and audit techniques (n=4). The studies assessed organizational measures, including relationships among staff, work satisfaction, continuity of care, workflow, compliance, workload, and cost. Interventions included using new technologies to improve handovers and communications, changing staff mixes, and introducing new shift structures, all of which had varying effects on the organizational measures listed previously. CONCLUSIONS Little research has assessed the organizational impact of duty hour reforms; however, the literature reviewed demonstrates that many organizations are using new technologies, new personnel, and revised and innovative shift structures to compensate for reduced resident coverage and to decrease the risk of limited continuity of care. Future research in this area should focus on both micro (e.g., use of technology, shift changes, staff mix) and macro (e.g., culture, leadership support) organizational aspects to aid in our understanding of how best to respond to these duty hour reforms.
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Affiliation(s)
- Madelyn P Law
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Elaina Orlando
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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