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

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

Study Overview

• Status: Unknown
• Conditions: Patient Safety; Resident Work Hours
• Intervention / Treatment: Behavioral: Intervention work shift

• Study Type: Interventional
• Enrollment (Anticipated): 80
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • British Columbia
    • Vancouver, British Columbia, Canada, V6Z1Y6
      • Recruiting
      • St Paul's Hospital
      • Contact: Najib Ayas, MD MPH; Phone Number: 604-806-9420; Email: Nayas@providencehealth.bc.ca
      • Principal Investigator: Najib Ayas, MD MPH
      • Sub-Investigator: Adam Peets, MD MSc
      • Sub-Investigator: Peter Dodek, MD MHSc
      • Sub-Investigator: Natalie Henrich, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

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

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Traditional work schedule; Residents in the intensive care unit perform overnight shifts in excess of 24 hrs every fourth night
Active Comparator: Intervention work schedule; Residents in the Intensive Care Unit perform shifts less than 16 hours in length and have at least 8 hours off between shifts	Behavioral: Intervention work shift; Shiftwork schedule with elimination of shifts greater than 16 hours in length and at least 8 hours off between shifts for all residents in the Intensive Care Unit

What is the study measuring?

Primary Outcome Measures

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

Secondary Outcome Measures

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

Collaborators and Investigators

• Sponsor: University of British Columbia
• Collaborators: Canadian Institutes of Health Research (CIHR); Michael Smith Foundation
• Investigators: Principal Investigator: Najib Ayas, MD MPH, University of British Columbia

Study record dates

Study Major Dates

• Study Start: July 1, 2011
• Primary Completion (Anticipated): June 1, 2012
• Study Completion (Anticipated): June 1, 2012

Study Registration Dates

• First Submitted: July 11, 2011
• First Submitted That Met QC Criteria: July 19, 2011
• First Posted (Estimate): July 21, 2011

Study Record Updates

• Last Update Posted (Estimate): July 25, 2011
• Last Update Submitted That Met QC Criteria: July 22, 2011
• Last Verified: July 1, 2011

More Information

Terms related to this study

• Keywords: Patient care; Medical education, graduate; Outcome assessment (Health care); Work schedule tolerance
• Other Study ID Numbers: H09-02007