Inpatient Attending Physician Rotation Duration Study

The investigators are testing the effects of a change in teaching attending physicians' rotations (from 4- to 2-week blocks) on patient outcomes (unplanned urgent visits to the health care system, inpatient mortality, and length-of-stay), the educational experiences of residents and medical students and on the quality of the professional lives of the attending physicians.

Study Overview

• Status: Completed
• Conditions: Inpatient Attending Physician Staffing Model
• Intervention / Treatment: Other: 2-week rotation; Other: 4-week rotation

Detailed Description

Design, Setting, and Participants Cluster randomized crossover noninferiority trial, with attending physicians as the unit of crossover randomization and 4-week rotations as the active control, conducted in a US university-affiliated teaching hospital in academic year 2009. Participants were 62 attending physicians who staffed at least 6 weeks of inpatient service, the 8892 unique patients whom they discharged, and the 147 house staff and 229 medical students who evaluated their performance.

Intervention Assignment to random sequences of 2- and 4-week rotations.

Main Outcome Measures Primary outcome was 30-day unplanned revisits (visits to the hospital's emergency department or urgent ambulatory clinic, unplanned readmissions, and direct transfers from neighboring hospitals) for patients discharged from 2- vs 4-week within-attending-physician rotations. Noninferiority margin was a 2% increase (odds ratio [OR] of 1.13) in 30-day unplanned patient revisits. Secondary outcomes were length of stay; trainee evaluations of attending physicians; and attending physician reports of burnout, stress, and workplace control.

• Study Type: Interventional
• Enrollment (Actual): 62
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Illinois
    • Chicago, Illinois, United States, 60612
      • Stroger Hospital of Cook County

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Attending physician on inpatient general medicine wards of Stroger Hospital, Chicago, IL

Exclusion Criteria:

• Scheduled for less than 6 weeks during the 2009 academic year

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: 2 weeks; Attending physicians are physician-of-records for traditional inpatient ward team (housestaff and medical students) for 2 weeks.	Other: 2-week rotation; Attending physician is assigned to a 2-week rotation.
Placebo Comparator: 4 weeks; Attending physicians are physician-of-records for traditional inpatient ward team (housestaff and medical students) for 4 weeks.	Other: 4-week rotation; Attending physician is assigned to a 4-week rotation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patients' unplanned urgent visits to the health care system.	Number pf non-scheduled patient encounters documented in the EHR	30 days after discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Resident physicians' evaluation of attending physicians' performance.	Self administered performance electronic evaluations - validated tool	During 14 or 28 day rotations
Medical students' evaluations of attending physicians' performance.	Self administered performance electronic evaluations	During 14 or 28 day rotations
Urgent visits to health care system among attending physicians' outpatient panel (if attending physician has an outpatient panel)	Number pf non-scheduled patient encounters documented in the EHR	During and 14 to 28 days after provider's rotation
Attending physicians' work-life balance, perceived stress, and perceived burn-out.	Self administered confidential Burnout assessment survey based on Conceptual Model of Burnout, Perceived Stress Scale & Maslach Burnout Inventory Human ServiceSurvey and a single item measure from the Notional Job Burnout Survey.	During 14 to 28 day rotations

Collaborators and Investigators

• Sponsor: Pamela Gonzalez Sr Director Clinical Research Office
• Investigators: Principal Investigator: Brian Lucas, MD, Cook County Health

Publications and helpful links

General Publications

• Lucas BP, Trick WE, Evans AT, Mba B, Smith J, Das K, Clarke P, Varkey A, Mathew S, Weinstein RA. Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial. JAMA. 2012 Dec 5;308(21):2199-207. doi: 10.1001/jama.2012.36522.

Study record dates

Study Major Dates

• Study Start: June 1, 2009
• Primary Completion (Actual): July 1, 2010
• Study Completion (Actual): December 1, 2010

Study Registration Dates

• First Submitted: June 29, 2009
• First Submitted That Met QC Criteria: June 29, 2009
• First Posted (Estimated): June 30, 2009

Study Record Updates

• Last Update Posted (Actual): July 11, 2023
• Last Update Submitted That Met QC Criteria: July 10, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Keywords: medical education; inpatient; professional practice; job satisfaction; residency; hospitalists; burnout, professional
• Other Study ID Numbers: 09-063 Cooker 533