Introduction of a 14-hour work shift model for housestaff in the medical ICU.
OBJECTIVE
To describe the outcomes of switching housestaff from a traditional model of "long-call" every 4 days to a 14-h work-shift model in a medical ICU (MICU) over a 5-week pilot period.


METHODS
Retrospective comparison of a 5-week pilot period for a 14-h work-shift model vs a 4-month period for the traditional model.


METHODS
The MICU of a tertiary medical center.


METHODS
A total of 626 patients admitted to the MICU and 34 internal medicine residents taking care of them.


METHODS
None.


METHODS
Severity-adjusted patient outcomes, housestaff performance on end-of-rotation examinations, and scheduled duty hours during the 5-week 14-h work-shift pilot period compared to a 16-week traditional nonpilot work period.


RESULTS
There were no statistically significant differences in patients' adjusted mortality rates, hospital lengths of stay, or housestaff performance on end-of-rotation knowledge assessment examinations between the pilot and nonpilot periods. During the pilot period, each resident was scheduled to work for an average of 61.3 h weekly, and each fellow for 65.3 h weekly. In comparison, each resident and fellow was scheduled to work for an average of 73.3 h weekly during the nonpilot period.


CONCLUSIONS
The 14-h work shift is a feasible option for housestaff rotation in the MICU. Although the power of our study to detect significant differences in mortality, length of stay, and educational outcomes was low, there was no evidence of compromised patient care or housestaff education associated with the 14-h shift model over the course of this 5-week pilot study.
Afessa
Bekele
B
Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA. afessa.bekele@mayo.edu
Kennedy
Cassie C
CC
Klarich
Kyle W
KW
Aksamit
Timothy R
TR
Kolars
Joseph C
JC
Hubmayr
Rolf D
RD
D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003422:Critical Care / Q000592:standards* / Q000639:trends; D004635:Emergency Medicine / Q000592:standards / Q000639:trends; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D010865:Pilot Projects; D011336:Probability; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012308:Risk Management; D016019:Survival Analysis; D014940:Work Schedule Tolerance; D000078329:Workforce; D016526:Workload