title: Redesign of an internal medicine ward rotation: operational challenges and outcomes.
abstract: BACKGROUND
  In anticipation of the 2011 ACGME duty hour requirements, we redesigned our internal medicine resident ward experience. Our previous ward structure included a maximum 30-hour duty period for postgraduate year-1 (PGY-1) residents. In the redesigned ward structure, PGY-1 residents had a maximum 18-hour duty period.
  
  
  METHODS
  We evaluated resident conference attendance and duty hour violations before and after implementation of our new ward redesign. We administered a satisfaction survey to residents and faculty 6 months after implementation of the new ward redesign.
  
  
  RESULTS
  Before implementation of the ward redesign, 30-hour continuous and 80-h/wk duty violations were each 2/year, and violations of the 10-hour rest between duty periods were 10/year for 74 residents. After implementation of the ward redesign, there were no 30-hour continuous or 80-h/wk duty violations, but violations of the 10-hour rest between duty periods more than doubled (26/year for 75 residents). Duty hours were reported by different mechanisms for the 2 periods. Conference attendance improved. Resident versus faculty satisfaction scores were similar. Both groups judged overall professional satisfaction as slightly worse after implementation.
  
  
  CONCLUSIONS
  Our ward rotation redesign eliminated 30-hour continuous and 80-h/wk duty violations as well as improved conference attendance. These benefits occurred at the cost of more faculty hires, decreased resident elective time, and slightly worse postimplementation satisfaction scores.
authors: J Rush
authors: JR
authors: Pierce
authors: Betty
authors: B
authors: Chang
authors: Kendall M
authors: KM
authors: Rogers
authors: Jennifer R
authors: JR
authors: Jernigan
authors: Dana R
authors: DR
authors: Fotieo
authors: Huining
authors: H
authors: Kang
authors: Robert R
authors: RR
authors: Leverence