title: The Influence of a Night-Float Call System on the Incidence of Unintentional Dural Puncture: A Retrospective Impact Study.
abstract: BACKGROUND
  Resident night-float systems have been associated with adverse outcomes. We hypothesized that an obstetric anesthesia night float would increase the incidence of unintentional dural punctures.
  
  
  METHODS
  The July to December incidence of unintentional dural puncture before (control group) and with night float (night-float group) was compared retrospectively. The incidence of unintentional dural puncture by day of week and trainee level was evaluated.
  
  
  RESULTS
  The unintentional dural puncture rate of control group was 0.73% (20 of 2758) vs 1.49% (39 of 2612) in the night-float group (P = 0.008; relative risk = 2.06; 95% confidence interval = 1.23-3.74). The proportion of unintentional dural punctures attributed to clinical anesthesia-1 residents in the night-float and control groups was 28.2% (11 of 39) and 5.0% (1 of 20), respectively (relative risk = 5.64; 95% confidence interval = 1.07-152; P = 0.044).
  
  
  CONCLUSIONS
  Implementation of night float increased the incidence of unintentional dural puncture.
authors: From the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Kelly G
authors: KG
authors: Elterman
authors: Lawrence C
authors: LC
authors: Tsen
authors: Chuan-Chin
authors: CC
authors: Huang
authors: Michaela K
authors: MK
authors: Farber
mesh_terms: D039602:After-Hours Care; D000761:Anesthesia Department, Hospital; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D002983:Clinical Competence; D004388:Dura Mater / Q000293:injuries*; D006801:Humans; D007268:Injections, Epidural; D007396:Internship and Residency; D010561:Personnel Staffing and Scheduling; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D000078329:Workforce