Patient Safety, Resident Work Hours
Conditions
Keywords
Medical education, graduate, Patient care, Outcome assessment (Health care), Work schedule tolerance
Brief summary
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.
Interventions
BEHAVIORALIntervention 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
Sponsors
Canadian Institutes of Health Research (CIHR)
Michael Smith Foundation
University of British Columbia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Preventable adverse events | 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 | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Resident leisure time, sleep, and time spent in the hospital | End of each 28 day rotation | Assessed by review of sleep/activity log |
| Professionalism | End of each 28 day rotation | 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. |
| Nursing impact | Over course of study (12 months) | 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. |
| Attending physician workload | Over course of study (12 months) | 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. |
| Quantity of scheduled and unscheduled learning activities residents participate in | End of each 28 day rotation | Assessed by review of sleep/activity log |
| Quality of life | End of each 28 day rotation | 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. |
| Resident knowledge acquisition and retention | End of each 28 day rotation | Scores on validated multiple choice question exams |
| Patient satisfaction | Within two weeks of ICU discharge | 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. |
| Job satisfaction/Stress | End of each 28 day rotation | 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. |
| Perceived continuity of care | Over course of study (12 months) | 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. |
Countries
Canada
Contacts
Primary ContactNajib Ayas, MD MPH
Outcome results
None listed