title: An observational pre-post study of re-structuring Medicine inpatient teaching service: Improved continuity of care within constraint of 2011 duty hours.
abstract: BACKGROUND
  Implementation of more stringent regulations on duty hours and supervision by the Accreditation Council for Graduate Medical Education in July 2011 makes it challenging to design inpatient Medicine teaching service that complies with the duty hour restrictions while optimizing continuity of patient care.
  
  
  OBJECTIVE
  To prospectively compare two inpatient Medicine teaching service structures with respect to residents' impression of continuity of patient care (primary outcome), time available for teaching, resident satisfaction and length-of-stay (secondary endpoints).
  
  
  METHODS
  Observational pre-post study.
  
  
  METHODS
  Surveys were conducted both before and after Conventional Medicine teaching service was changed to a novel model (MegaTeam).
  
  
  METHODS
  Academic General Medicine inpatient teaching service.
  
  
  RESULTS
  Surveys before and after MegaTeam implementation were completed by 68.5% and 72.2% of internal medicine residents, respectively. Comparing conventional with MegaTeam, the % of residents who agreed or strongly agreed that the (i) ability to care for majority of patients from admission to discharge increased from 29.7% to 86.6% (p<0.01); (ii) the concern that number of handoffs was too many decreased from 91.9% to 18.2% (p<0.01); (iii) ability to provide appropriate supervision to interns increased from 38.1% to 70.7% (p<0.01); (iv) overall resident satisfaction with inpatient Medicine teaching service increased from 24.7% to 56.4% (p<0.01); and (v) length-of-stay on inpatient Medicine service decreased from 5.3±6.2 to 4.9±6.8 days (p<0.03).
  
  
  CONCLUSIONS
  According to our residents, the MegaTeam structure promotes continuity of patient care, decreases number of handoffs, provides adequate supervision and teaching of interns and medical students, increases resident overall satisfaction and decreases length-of-stay.
authors.affiliation: Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA. Electronic address: Joseph.cheung@tuhs.temple.edu.
authors.forename: Joseph Y
authors.initials: JY
authors.lastname: Cheung
authors.affiliation: Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mueller
authors.affiliation: Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Marissa
authors.initials: M
authors.lastname: Blum
authors.affiliation: Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Ravreby
authors.affiliation: Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Williams
authors.affiliation: Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Darilyn
authors.initials: D
authors.lastname: Moyer
authors.affiliation: Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Malka
authors.initials: M
authors.lastname: Caroline
authors.affiliation: Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Zack
authors.affiliation: Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Fisher
authors.affiliation: Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Feldman
mesh_terms: D003266:Continuity of Patient Care; D006801:Humans; D007297:Inpatients; D008511:Medicine; D013663:Teaching
keywords: ACGME duty hour restrictions; Continuity of patient care; Housestaff satisfaction; Patient handoff; Resident education