Implementing duty-hour restrictions without diminishing patient care or education: can it be done?
OBJECTIVE
To implement and evaluate a new ward team call system that would meet the Accreditation Council on Graduate Medical Education's (ACGME) duty-hour requirements without compromising patient care or detracting from resident education.


METHODS
The new system was implemented in the internal medicine residency program at the University Hospital at the University of Cincinnati Medical Center. In 2003-04, residents and faculty were surveyed about their experiences with the new and old ward systems relative to duty-hour requirements, patient care, and resident education. Responses were given on a five-point scale (5 = strongly agree, 1 = strongly disagree). Data were compiled and compared using a two-sample t-test.


RESULTS
Faculty believed the new system improved compliance with the duty-hour requirements (mean = 4.3, 95% confidence interval [CI]: 4.1-4.6), although were neutral regarding patient care (mean = 3.5, 95% CI: 3.2-3.8) and education (mean = 3.3, 95% CI: 2.9-3.6). Residents were more neutral regarding ACGME requirements (mean = 3.5, 95% CI: 3.3-3.7) and patient care (mean = 3.2, 95% CI 3.0-3.3). Residents reported a slightly negative impact on education (mean = 2.8, 95% CI: 2.5-3.0). In response to an exclusive question, residents reported that the new system did not reduce fatigue (mean = 2.7, 95% CI: 2.6-3.0).


CONCLUSIONS
Respondents perceived that this ward call system met ACGME requirements and maintained quality patient care but may have sacrificed some traditional resident education tenets.
Mathis
Bradley R
BR
Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0557, USA.
Diers
Tiffiny
T
Hornung
Richard
R
Ho
Mona
M
Rouan
Gregory W
GW
D000046:Academic Medical Centers / Q000458:organization & administration; D001291:Attitude of Health Personnel; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000458:organization & administration*; D009820:Ohio; D009936:Organizational Innovation; D010348:Patient Care Team / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D015397:Program Evaluation; D011787:Quality of Health Care; D016526:Workload