Restructuring an inpatient resident service to improve outcomes for residents, students, and patients.
OBJECTIVE
This study assesses the effects of a resident teaching service restructuring on resident, student, and patient outcomes.


METHODS
Interventions included eliminating a "day float" admitting team, converting one-resident:one-intern teams to one-resident:two-intern teams, reducing patient caps from 11 to 7 patients per intern, and increasing pairing between resident teams and attendings. Resident end-of-rotation evaluations and time spent in categorized activities; student end-of-clerkship evaluations, patient logs, and subject exam scores; and hospital-collected patient outcome data were compared before (2007-2008) versus after (2008-2009) the changes.


RESULTS
Interns covered fewer patients per day post intervention (9.9 apiece to 6.3 apiece), whereas the total number of patients covered increased (2,501 to 2,916). Enjoyment of the rotation was higher post intervention for interns and senior residents. Residents' time in direct patient care activities and with interns increased post intervention, but residents spent less time with medical students. Students' ratings of several aspects of the clerkship were significantly higher in the postintervention year. Students evaluated more previously unevaluated patients post intervention (32.6% to 45.8%, P < .001), but subject exam scores were unchanged. The median length of stay decreased post intervention (5.0 to 4.0 days, P = .02), and fewer patients required ICU care (11.2% to 7.9%, P < .001). These differences persisted after adjusting for multiple covariates.


CONCLUSIONS
An intervention that reduced handoffs and intern patient census and that increased hospitalist pairing was associated with improved resident and student experiences, a favorable impact on patient outcomes, and probable cost savings.
University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. alec_oconnor@urmc.rochester.edu
Alec B
AB
O'Connor
Valerie J
VJ
Lang
Donald R
DR
Bordley
D000328:Adult; D004501:Education, Medical / Q000458:organization & administration*; D005260:Female; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000458:organization & administration*; D007588:Job Satisfaction; D007902:Length of Stay; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge / Q000706:statistics & numerical data; D061214:Patient Safety; D010549:Personal Satisfaction; D011787:Quality of Health Care; D013337:Students, Medical / Q000706:statistics & numerical data; D014481:United States