title: Service census caps and unit-based admissions: resident workload, conference attendance, duty hour compliance, and patient safety.
abstract: OBJECTIVE
  To examine the effect of census caps and unit-based admissions on resident workload, conference attendance, duty hour compliance, and patient safety.
  
  
  METHODS
  We implemented a census cap of 14 patients on 6 Mayo Clinic internal medicine resident hospital services and a unit-based admissions process in which patients and care teams were consolidated within hospital units. All 280 residents and 15,926 patient admissions to resident and nonresident services 1 year before the intervention (September 1, 2006, through August 31, 2007) and 1 year after the intervention (May 1, 2008, through April 30, 2009) were included. Residents' workload, conference attendance, and duty hours were tracked electronically. Patient safety variables including Rapid Response Team and cardiopulmonary resuscitation events, intensive care unit transfers, Patient Safety Indicators, and 30-day readmissions were compared preintervention and postintervention.
  
  
  RESULTS
  After the intervention, residents' mean (SE) ratings of workload appropriateness improved (3.10 [0.08] vs 3.87 [0.08] on a 5-point scale; P<.001), as did conference attendance (1523 [56. 8%] vs 1700 [63.5%] conferences attended; P<.001). Duty hour violations for working more than 30 consecutive hours and not having 10 hours off between duty periods decreased from 77 of 9490 possible violations (0.81%) to 27 (0.28%) and from 70 (0.74%) to 14 (0.15%) violations, respectively (both, P<.001). Thirty-day readmissions to resident services decreased (1010 [18.14%] vs 682 [15. 37%]; P<.001). All other patient safety measures remained unchanged. After adjustment for illness severity, there were no significant differences in patient outcomes between resident and nonresident services.
  
  
  CONCLUSIONS
  Census caps and unit-based admissions were associated with improvements in resident workload, conference attendance, duty hour compliance, and readmission rates while patient outcomes were maintained.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN 59906, USA. thanarajasingam.uma@mayo.edu
authors.forename: Uma
authors.initials: U
authors.lastname: Thanarajasingam
authors.forename: Furman S
authors.initials: FS
authors.lastname: McDonald
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Halvorsen
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.forename: Rosa L
authors.initials: RL
authors.lastname: Cabanela
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Johnson
authors.forename: Paul R
authors.initials: PR
authors.lastname: Daniels
authors.forename: Amy W
authors.initials: AW
authors.lastname: Williams
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Reed
mesh_terms: D003226:Congresses as Topic; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling; D011446:Prospective Studies; D014940:Work Schedule Tolerance; D016526:Workload