title: No Variation in Patient Care Outcomes After Implementation of Resident Shift Work Duty Hour Limitations and a Hospitalist Model System.
abstract: This study examines whether implementing a resident shift work schedule (RSWS) alone or combined with a hospitalist-led model system (HMS/RSWS) affects patient care outcomes or costs at a pediatric tertiary care teaching hospital. A retrospective sample compared pre- and postintervention groups for the most common primary discharge diagnoses, including asthma and cellulitis (RSWS intervention) and inflammatory bowel disease and diabetic ketoacidosis (HMS/RSWS intervention). Outcome variables included length of stay, number of subspecialty consultations, and hospitalization charges. For the RSWS intervention, the preintervention (n = 107) and postintervention (n = 92) groups showed no difference in any of the outcome variables. For the HMS/RSWS intervention, the preintervention (n = 98) and postintervention (n = 69) groups did not differ in demographics or length of stay. However, subspecialty consultations increased significantly during postintervention from 0.83 to 1.52 consults/hospitalization ( P < .01) without significantly increasing hospitalization charges. Neither the RSWS nor HMS/RSWS intervention affected patient care outcomes at a pediatric tertiary care teaching hospital.
authors.affiliation: 1 Department of Pediatrics, Baylor College of Medicine, Houston, TX.
authors.forename: John M
authors.initials: JM
authors.lastname: Hollier
authors.affiliation: 2 Department of Pediatrics, University of California San Francisco, San Francisco, CA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Wilson
mesh_terms: D001249:Asthma / Q000628:therapy; D002481:Cellulitis / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D016883:Diabetic Ketoacidosis / Q000628:therapy; D017722:Hospital Charges; D020445:Hospitalists / Q000191:economics / Q000458:organization & administration*; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006784:Hospitals, Teaching / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015212:Inflammatory Bowel Diseases / Q000628:therapy; D007396:Internship and Residency / Q000191:economics / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration; D012189:Retrospective Studies; D013038:Specialization
keywords: hospitalist; length of stay; quality of care; resident duty hours; resident shift work