title: Implications of transitioning to a resident night float system in neurosurgery: mortality, length of stay, and resident experience.
abstract: OBJECTIVE Many neurosurgical training programs have moved from a 24-hour resident call system to a night float system, but the impact on outcomes is unclear. Here, the authors compare length of stay (LOS) for neurosurgical patients admitted before and after initiation of a night float system at a tertiary care training hospital. METHODS The neurosurgical residency at the University of Alabama at Birmingham transitioned from 24-hour call to a night float resident coverage system in July 2013. In this cohort study, all patients admitted to the neurosurgical service for 1 year before and 1 year after this transition were compared with respect to hospital and ICU LOSs, adjusted for potential confounders. RESULTS A total of 4619 patients were included. In the initial bivariate analysis, night float was associated with increased ICU LOS (p = 0.032) and no change in overall LOS (p = 0.65). However, coincident with the transition to a night float system was an increased frequency of resident service transitions, which were highly associated with hospital LOS (p < 0.01) and ICU LOS (p < 0.01). After adjusting for resident service transitions, initiation of the night float system was associated with decreased hospital LOS (p = 0.047) and no change in ICU LOS (p = 0.35). CONCLUSIONS This study suggests that a dedicated night float resident may improve night-to-night continuity of care and decrease hospital LOS, but caution must be exercised when initiation of night float results in increased resident service transitions.
authors.affiliation: Department of Neurosurgery and.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Davis
authors.affiliation: Department of Neurosurgery and.
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Kuhn
authors.affiliation: Department of Neurosurgery and.
authors.forename: Bonita S
authors.initials: BS
authors.lastname: Agee
authors.affiliation: Center for Clinical and Translational Sciences, University of Alabama at Birmingham, Alabama.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Oster
authors.affiliation: Department of Neurosurgery and.
authors.forename: James M
authors.initials: JM
authors.lastname: Markert
mesh_terms: D000046:Academic Medical Centers; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D000069471:Neurosurgeons / Q000523:psychology*; D009493:Neurosurgery / Q000193:education* / Q000379:methods*; D010359:Patient Readmission / Q000639:trends; D012189:Retrospective Studies
keywords: ACGME = Accreditation Council for Graduate Medical Education; ANCOVA = analysis of covariance; DRG = diagnosis-related group; LOS = length of stay; PGY = postgraduate year; UAB = University of Alabama at Birmingham; length of stay; neurosurgery; patient handoff; patient outcome assessment