Chest
Volume 128, Issue 6, December 2005, Pages 3910-3915
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Clinical Investigations in Critical Care
Introduction of a 14-Hour Work Shift Model for Housestaff in the Medical ICU

https://doi.org/10.1378/chest.128.6.3910Get rights and content

Study objective:

To describe the outcomes of switching housestaff from a traditional model of “long-call” every 4 days to a 14-h work-shift model in a medical ICU (MICU) over a 5-week pilot period.

Design:

Retrospective comparison of a 5-week pilot period for a 14-h work-shift model vs a 4-month period for the traditional model.

Setting:

The MICU of a tertiary medical center.

Participants:

A total of 626 patients admitted to the MICU and 34 internal medicine residents taking care of them.

Interventions:

None.

Measurements:

Severity-adjusted patient outcomes, housestaff performance on end-of-rotation examinations, and scheduled duty hours during the 5-week 14-h work-shift pilot period compared to a 16-week traditional nonpilot work period.

Results:

There were no statistically significant differences in patients’ adjusted mortality rates, hospital lengths of stay, or housestaff performance on end-of-rotation knowledge assessment examinations between the pilot and nonpilot periods. During the pilot period, each resident was scheduled to work for an average of 61.3 h weekly, and each fellow for 65.3 h weekly. In comparison, each resident and fellow was scheduled to work for an average of 73.3 h weekly during the nonpilot period.

Conclusions:

The 14-h work shift is a feasible option for housestaff rotation in the MICU. Although the power of our study to detect significant differences in mortality, length of stay, and educational outcomes was low, there was no evidence of compromised patient care or housestaff education associated with the 14-h shift model over the course of this 5-week pilot study.

Section snippets

Materials and Methods

From March 27, 2004, to April 30, 2004, we piloted a 14-h shift-work model for internal medicine residents and critical care fellows in a 24-bed MICU. The outcomes during this pilot period were compared with those during the nonpilot period. We considered the 2 months before and the 2 months after the pilot to be the nonpilot period. During the pilot and nonpilot periods, the staffing support provided by allied health professionals was maintained at a constant level. The Institutional Review

Patient Care

Thirty-five patients who did not authorize their medical records to be reviewed for research and 15 patients whose MICU care overlapped the two study periods were excluded from the study. Based on the APACHE III database, the daily census was 16.6 and 14.4 patients, respectively, for the pilot and nonpilot periods. The baseline and outcome characteristics of the study patients admitted to the MICU during the pilot period are outlined in Table 1. There were no statistically significant

Discussion

This study describes our experience with a 14-h work-shift model for housestaff in the MICU of a tertiary, academic medical center. Although the study was limited by inadequate sample size, we were not able to identify any objective evidence of compromise in patient care or housestaff education associated with the model. All residents were able to complete scholastic work during the pilot period.

Although limiting housestaff working hours has not been shown to reduce patient mortality rates, it

Appendix 1: Housestaff Rotation in the MICU During the Nonpilot Period

  • 1

    During the nonpilot period, the MICU service was split into two separate services (called “blue” and “green”). Each service consisted of one consultant, two critical care fellows, and two third-year and two first-year internal medicine residents. Each service was subdivided into two teams of one fellow, one third-year resident, and one first-year resident. Thus, there were four teams, and each team was on long call every fourth night. One team was also assigned to short-call responsibilities

Appendix 2: The Shift Model for Housestaff Rotation in the MICU

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    Internal medicine residents and critical care fellows rotate in the MICU in shifts of 14 h, from 7:00 am to 9:00 pm and from 7:00 pm to 9:00 am. The day shift is made up of a team of two fellows and three residents, and the night team by two fellows and two residents. The MICU was staffed by two critical care attending consultants, who were on call every other night. The consultants are responsible for making sure residents complete their duty by 9:00 pm for the day shift and by 9:00 am for the

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    This research was supported by the Department of Medicine, Mayo Clinic College of Medicine.

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