title: How do hospitalized patients feel about resident work hours, fatigue, and discontinuity of care?
abstract: BACKGROUND
  Patient-centered care requires that physicians understand patients' perspectives. Since the resident work hour rules were instituted, little information is available about how patients perceive these issues. Our objectives were to explore patients' knowledge, concerns, and attitudes about resident work hours, fatigue, and continuity of inpatient care and to evaluate the association between patients' trust and satisfaction with these concerns and attitudes.
  
  
  METHODS
  We conducted a cross-sectional survey of 134 internal medicine inpatients at 3 institutions including a tertiary care academic health center, a Veterans Affairs medical center, and a private community teaching hospital.
  
  
  RESULTS
  Mean age was 59 (range, 24-90), with 60% men and 70% white. Most patients agreed (50%) or felt neutral (38%) toward resident work hours being limited. Patients estimated that residents worked 60 h per week but thought that they should work no more than 51 h per week (p < .01 for the difference). Twenty-seven percent of patients had some concern about fatigue in the residents, and 28% reported concern about how often hand-offs of care occurred. Factor analysis yielded 3 factors: "worried about discontinuity/fatigue," "attitude toward resident/nurse work hours," and "perceived resident/nurse fatigue." In multivariable analyses, the "worried about fatigue/discontinuity" factor significantly predicted trust and satisfaction, and the "perceived resident/nurse fatigue" factor also predicted satisfaction.
  
  
  CONCLUSIONS
  Some inpatients are concerned about both fatigue in resident physicians and discontinuity of care. This may play a role in trust and satisfaction for patients. Taking steps to design systems to minimize fatigue and discontinuity would be ideal.
authors.affiliation: Clement J. Zablocki VAMC, Milwaukee, WI, USA. kfletche@mcw.edu
authors.forename: Kathlyn E
authors.initials: KE
authors.lastname: Fletcher
authors.forename: Francine C
authors.initials: FC
authors.lastname: Wiest
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Halasyamani
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lin
authors.forename: Victoria
authors.initials: V
authors.lastname: Nelson
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Kaufman
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.forename: Marilyn
authors.initials: M
authors.lastname: Schapira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D005260:Female; D006764:Hospitals, Community; D006785:Hospitals, University; D006787:Hospitals, Veterans; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009726:Nurses; D017060:Patient Satisfaction; D010361:Patients; D010561:Personnel Staffing and Scheduling; D010817:Physician-Patient Relations; D035502:Trust; D014481:United States; D014940:Work Schedule Tolerance; D016526:Workload