title: Shifting indirect patient care duties to after hours in the era of work hours restrictions.
abstract: OBJECTIVE
  Few data describe how often residents defer indirect patient care tasks to after hours or show whether residents report this time in duty hours logs. Thus, the authors examined how often residents perform one such task, discharge dictation, outside scheduled hours.
  
  
  METHODS
  The authors tracked all discharge summaries dictated by internal medicine residents at a single teaching hospital from January to June 2009. They determined the length and timing of discharge dictations by querying the hospital voice-dictation system. Definite work hours violations occurred when residents completed dictations on the postcall day after reaching mandated duty hours limits or on scheduled days off. Potential work hours violations arose when residents dictated after 6 pm or during the month subsequent to their rotation. The authors compared the number of residents they determined to have incurred duty hours violations with the number self-reporting violations.
  
  
  RESULTS
  The authors obtained data on 1,152 dictations performed by 39 residents. Residents spent a mean 6.5 hours dictating per month, averaging 13 minutes per dictation. Using objective criteria, the authors determined that the majority of residents (32; 82%) incurred definite duty hours violations. Far fewer (2; 5%) self-reported violations. Team census, total time spent dictating, and dictation length were associated with dictating during restricted hours.
  
  
  CONCLUSIONS
  Indirect patient care tasks, such as dictating discharge summaries, may contribute substantially to unrecognized duty hours violations. Accurate and objective ways to assess resident workflow can help create effective solutions for resident efficiency and inform changes to resident schedules.
authors: Division of Hospital Medicine, University of California San Francisco, San Francisco, California 94143, USA. Michelle.Mourad@ucsf.edu.
authors: Michelle
authors: M
authors: Mourad
authors: Arpana R
authors: AR
authors: Vidyarthi
authors: Harry
authors: H
authors: Hollander
authors: Sumant R
authors: SR
authors: Ranji
mesh_terms: D039602:After-Hours Care / Q000331:legislation & jurisprudence*; D002140:California; D015331:Cohort Studies; D005260:Female; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D020380:Needs Assessment; D005791:Patient Care / Q000379:methods*; D010561:Personnel Staffing and Scheduling; D011786:Quality Control; D013647:Task Performance and Analysis; D014940:Work Schedule Tolerance; D016526:Workload / Q000331:legislation & jurisprudence*