Inpatient Attending Physician Staffing Model
Conditions
Keywords
inpatient, hospitalists, residency, job satisfaction, burnout, professional, professional practice, medical education
Brief summary
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.
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.
Interventions
OTHER2-week rotation
Attending physician is assigned to a 2-week rotation.
OTHER4-week rotation
Attending physician is assigned to a 4-week rotation.
Sponsors
Pamela Gonzalez Sr Director Clinical Research Office
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patients' unplanned urgent visits to the health care system. | 30 days after discharge | Number pf non-scheduled patient encounters documented in the EHR |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Resident physicians' evaluation of attending physicians' performance. | During 14 or 28 day rotations | Self administered performance electronic evaluations - validated tool |
| Medical students' evaluations of attending physicians' performance. | During 14 or 28 day rotations | Self administered performance electronic evaluations |
| Urgent visits to health care system among attending physicians' outpatient panel (if attending physician has an outpatient panel) | During and 14 to 28 days after provider's rotation | Number pf non-scheduled patient encounters documented in the EHR |
| Attending physicians' work-life balance, perceived stress, and perceived burn-out. | During 14 to 28 day rotations | 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. |
Countries
United States
Outcome results
None listed