title: Association between ordering patterns and shift-based care in general pediatrics inpatients.
abstract: Duty-hour restrictions have forced changes in care models for inpatient services, including an increase in shift work. In this study we aimed to determine whether a shift model compliant with 2011 Accreditation Council for Graduate Medical Education duty-hour standards was associated with more active patient care management. Residents caring for pediatric patients changed from a schedule with extended duty shifts and cross-coverage to one based on day/night shifts, limiting interns to 16 consecutive duty hours. We conducted a retrospective review of orders written under each model. After the intervention, there was a significant increase in the mean number of orders written within the first 12 hours (pre: 0.58 orders vs post: 1.12, P = 0.009) and 24 hours (pre: 1.52 vs post: 2.38, P = 0.004) following admission (not including admission orders), but we did not detect a significantly higher percentage of orders written at night. This shift-based coverage system was associated with a greater number of orders written early in the hospitalization, indicating more active management of clinical problems.
authors.affiliation: University of California, San Francisco, School of Medicine, San Francisco, California.
authors.forename: Neelaysh
authors.initials: N
authors.lastname: Vukkadala
authors.affiliation: Division of Hospital Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Auerbach
authors.affiliation: Division of Hospital Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Maselli
authors.affiliation: Division of Pediatric Hospital Medicine, University of California, San Francisco, Benioff Children's Hospital, San Francisco, California.
authors.forename: Glenn
authors.initials: G
authors.lastname: Rosenbluth
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007396:Internship and Residency; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008499:Medical Records / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000193:education*; D010561:Personnel Staffing and Scheduling; D012189:Retrospective Studies; D014481:United States; D016526:Workload / Q000592:standards