title: An innovative on-call system for paediatric residency programs: The alternate night float.
abstract: BACKGROUND
  Night-float systems, in which residents work consecutive nights, have been increasingly adopted in paediatric programs, but may be detrimental to residents' sleep and mood.
  
  
  OBJECTIVE
  To describe the self-reported impact of a novel system consisting of two consecutive weeks of 16 h overnight shifts every second day that was piloted at the Children's Hospital of Eastern Ontario (Ottawa, Ontario).
  
  
  METHODS
  A survey of 28 senior paediatric residents examined their experience with the alternate night-float system in three domains (patient care, resident professional development and well-being) and their comparison of the system with the traditional overnight on-call system.
  
  
  RESULTS
  Twenty-six of 28 residents responded. Nearly all (96%) felt familiar with important details of inpatients and that handover was effective (92%). Results were mixed for professional development, with concerns about the quality of supervisors' feedback and perceived difficulty in attending daytime teaching. All residents believed that the night-float system provided a better learning experience compared with the traditional system. Less than 35% considered fatigue to be a notable problem, although 20% increased use of sleep aids or stimulants beyond their typical use. Ninety-six percent believed their workload was appropriate. All residents felt equally or less fatigued under the night-float system compared with the traditional system. Ninety-six percent recommended that the night-float model continue as the on-call system.
  
  
  CONCLUSIONS
  This novel night-float system is an alternative method of providing paediatric inpatient night coverage because it meets duty hour regulations and has strong resident approval. Studies to examine its impact on residents and patient care in comparison with other systems are warranted.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario; ; Department of Obstetrics and Gynecology, Division of Newborn Care, The Ottawa Hospital - General Campus, Ottawa;
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Moore
authors.affiliation: Department of Pediatrics, Division of Pediatric Medicine The Hospital for Sick Children;
authors.forename: Susanna
authors.initials: S
authors.lastname: Talarico
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto;
authors.forename: Anna
authors.initials: A
authors.lastname: Kempinska
authors.affiliation: Department of Pediatrics, Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa;
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lawrence
authors.affiliation: Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario.
authors.forename: Dany E
authors.initials: DE
authors.lastname: Weisz
keywords: Attitude of health personnel; Paediatrics; Personnel staffing and scheduling
references.citation: Jt Comm J Qual Patient Saf. 2007 Nov;33(11 Suppl):7-18
references.pmid: 18173162
references.citation: Ann Intern Med. 2010 Dec 21;153(12):829-42
references.pmid: 21173417
references.citation: N Engl J Med. 2012 Nov 22;367(21):2044-9
references.pmid: 23171102
references.citation: Pediatrics. 2011 Dec;128(6):1142-7
references.pmid: 22123867
references.citation: Chronobiol Int. 2002 Sep;19(5):893-902
references.pmid: 12405552
references.citation: N Engl J Med. 1988 Mar 24;318(12):775-8
references.pmid: 3347227
references.citation: J Gen Intern Med. 1990 Nov-Dec;5(6):501-5
references.pmid: 2266432
references.citation: Anesth Analg. 2012 Jul;115(1):102-15
references.pmid: 22543067
references.citation: Ann Intern Med. 1994 Dec 1;121(11):866-72
references.pmid: 7978700
references.citation: N Engl J Med. 2004 Oct 28;351(18):1838-48
references.pmid: 15509817
references.citation: N Engl J Med. 2012 Jun 14;366(24):e35
references.pmid: 22646511
references.citation: J Am Coll Surg. 2002 Oct;195(4):531-8
references.pmid: 12375759
references.citation: J Gen Intern Med. 1993 Mar;8(3):146-8
references.pmid: 8455112
references.citation: Ergonomics. 2003 Jun 10;46(7):653-63
references.pmid: 12745679
references.citation: Obstet Gynecol. 1989 Oct;74(4):668-72
references.pmid: 2797646
references.citation: J Grad Med Educ. 2010 Jun;2(2):236-41
references.pmid: 21975627
references.citation: Chest. 2006 Aug;130(2):624-5; author reply 625
references.pmid: 16899875
references.citation: N Engl J Med. 2013 Feb 21;368(8):694-7
references.pmid: 23425162
references.citation: Postgrad Med. 2012 Jul;124(4):241-9
references.pmid: 22913912
references.citation: PLoS Med. 2006 Dec;3(12):e487
references.pmid: 17194188
references.citation: BMC Health Serv Res. 2006 Oct 19;6:136
references.pmid: 17052349
references.citation: Am J Dis Child. 1992 Mar;146(3):307-10
references.pmid: 1543177