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Maloney A, Kanaley JA. Short Sleep Duration Disrupts Glucose Metabolism: Can Exercise Turn Back the Clock? Exerc Sport Sci Rev 2024; 52:77-86. [PMID: 38608214 PMCID: PMC11168896 DOI: 10.1249/jes.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Short sleep duration is prevalent in modern society and may be contributing to type 2 diabetes prevalence. This review will explore the effects of sleep restriction on glycemic control, the mechanisms causing insulin resistance, and whether exercise can offset changes in glycemic control. Chronic sleep restriction may also contribute to a decrease in physical activity leading to further health complications.
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Affiliation(s)
- Alan Maloney
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
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2
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Fogleman BM, Goldman M, Holland AB, Dyess G, Patel A. Charting Tomorrow's Healthcare: A Traditional Literature Review for an Artificial Intelligence-Driven Future. Cureus 2024; 16:e58032. [PMID: 38738104 PMCID: PMC11088287 DOI: 10.7759/cureus.58032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Electronic health record (EHR) systems have developed over time in parallel with general advancements in mainstream technology. As artificially intelligent (AI) systems rapidly impact multiple societal sectors, it has become apparent that medicine is not immune from the influences of this powerful technology. Particularly appealing is how AI may aid in improving healthcare efficiency with note-writing automation. This literature review explores the current state of EHR technologies in healthcare, specifically focusing on possibilities for addressing EHR challenges through the automation of dictation and note-writing processes with AI integration. This review offers a broad understanding of existing capabilities and potential advancements, emphasizing innovations such as voice-to-text dictation, wearable devices, and AI-assisted procedure note dictation. The primary objective is to provide researchers with valuable insights, enabling them to generate new technologies and advancements within the healthcare landscape. By exploring the benefits, challenges, and future of AI integration, this review encourages the development of innovative solutions, with the goal of enhancing patient care and healthcare delivery efficiency.
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Affiliation(s)
- Brody M Fogleman
- Internal Medicine, Edward Via College of Osteopathic Medicine - Carolinas, Spartanburg, USA
| | - Matthew Goldman
- Neurological Surgery, Houston Methodist Hospital, Houston, USA
| | - Alexander B Holland
- General Surgery, Edward Via College of Osteopathic Medicine - Carolinas, Spartanburg, USA
| | - Garrett Dyess
- Medicine, University of South Alabama College of Medicine, Mobile, USA
| | - Aashay Patel
- Neurological Surgery, University of Florida College of Medicine, Gainesville, USA
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3
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Costa-Font J, Fleche S, Pagan R. The labour market returns to sleep. JOURNAL OF HEALTH ECONOMICS 2024; 93:102840. [PMID: 37995463 DOI: 10.1016/j.jhealeco.2023.102840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 09/20/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
Despite the growing prevalence of insufficient sleep among individuals, we still know little about the labour market return to sleep. To address this gap, we use longitudinal data from Germany and leverage exogenous fluctuations in sleep duration caused by variations in time and local sunset times. Our findings reveal that a one-hour increase in weekly sleep is associated with a 1.6 percentage point rise in employment and a 3.4% increase in weekly earnings. Such effect on earnings stems from productivity improvements given that the number of working hours decreases with longer sleep duration. We also identify a key mechanism driving these effects, namely the enhanced mental well-being experienced by individuals who sleep longer hours.
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Affiliation(s)
- Joan Costa-Font
- London School of Economics and Political Science (LSE), United Kingdom; IZA, Germany; CESifo, Germany.
| | - Sarah Fleche
- University Paris 1 Pantheon-Sorbonne, CNRS, Sorbonne Economics Centre, France; Centre for Economic Performance (LSE), United Kingdom.
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Kelley AT, Wilcox J, Baylis JD, Crossnohere NL, Magel J, Jones AL, Gordon AJ, Bridges JFP. Increasing Access to Buprenorphine for Opioid Use Disorder in Primary Care: an Assessment of Provider Incentives. J Gen Intern Med 2023; 38:2147-2155. [PMID: 36471194 PMCID: PMC10361924 DOI: 10.1007/s11606-022-07975-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary care providers (PCPs) are essential to increasing access to office-based buprenorphine medication treatment for opioid use disorder (B-MOUD). Barriers to B-MOUD prescribing are well-documented, but there is little information regarding incentives to overcome these barriers. OBJECTIVE To identify optimal incentives for PCPs to promote B-MOUD prescribing and compare incentive preferences across provider and practice characteristics. DESIGN We surveyed PCPs using best-worst scaling (BWS) to prioritize seven potential incentives for B-MOUD prescribing (monetary compensation, paid vacation, protected time, professional development, reduced workload, service recognition, clinical resources). We then used a direct elicitation approach to determine preferred incentive levels (e.g., monetary thresholds) and types (e.g., specific clinical resources). PARTICIPANTS Primary care physicians and advanced practice providers (APPs) at a large Department of Veterans Affairs healthcare system. MAIN MEASURES B-MOUD prescribing incentive preferences and relative preference levels using descriptive statistics and conditional logistic regression with relative importance scale transformation (coefficients sum to 100, higher coefficient=greater importance). KEY RESULTS Fifty-three PCPs responded (73% response), including 47% APPs and 36% from community-based clinics. Reduced workload (relative importance score=26.8), protected time (18.7), and clinical resources (16.8) were significantly more preferred (Ps < 0.001) than professional development (10.5), paid vacation (10.3), or service recognition (1.5). Relative importance of monetary compensation varied between physicians (12.6) and APPs (17.5) and between PCPs located at a medical center (11.4) versus community clinic (22.3). APPs were more responsive than physicians to compensation increases of $5000 and $12,000 but less responsive to $25,000; trends were similar for medical center versus community clinic PCPs. The most frequently requested clinical resource was on-demand consult access to an addiction specialist. CONCLUSIONS Interventions promoting workload reductions, protected time, and clinical resources could increase access to B-MOUD in primary care. Monetary incentives may be additionally needed to improve B-MOUD prescribing among APPs and within community clinics.
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Affiliation(s)
- A Taylor Kelley
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 50 North Medical Drive, 5R341, Salt Lake City, UT, 84132, USA.
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jordynn Wilcox
- Office of the Director, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Jacob D Baylis
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Norah L Crossnohere
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John Magel
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, Salt Lake City, UT, USA
| | - Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Greater Intermountain Node (GIN) of the NIDA Clinical Trials Network, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
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Zhang D, Gu D, Rao C, Zhang H, Su X, Chen S, Ma H, Zhao Y, Feng W, Sun H, Zheng Z. Outcome differences between surgeons performing first and subsequent coronary artery bypass grafting procedures in a day: a retrospective comparative cohort study. BMJ Qual Saf 2023; 32:192-201. [PMID: 35649696 DOI: 10.1136/bmjqs-2021-014244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND With increasing surgical workload, it is common for cardiac surgeons to perform coronary artery bypass grafting (CABG) after other procedures in a workday. To investigate whether prior procedures performed by the surgeon impact the outcomes, we compared the outcomes between CABGs performed first versus those performed after prior procedures, separately for on-pump and off-pump CABGs as they differed in technical complexity. METHODS We conducted a retrospective cohort study of patients undergoing isolated CABG in China from January 2013 to December 2018. Patients were categorised as undergoing on-pump and off-pump CABGs. Outcomes of the procedures performed first in primary surgeons' daily schedule (first procedure) were compared with subsequent ones (non-first procedure). The primary outcome was an adverse events composite (AEC) defined as the number of adverse events, including in-hospital mortality, myocardial infarction, stroke, acute kidney injury and reoperation. Secondary outcomes were the individual components of the primary outcome, presented as binary variables. Mixed-effects models were used, adjusting for patient and surgeon-level characteristics and year of surgery. RESULTS Among 21 866 patients, 10 109 (16.1% as non-first) underwent on-pump and 11 757 (29.6% as non-first) off-pump CABG. In the on-pump cohort, there was no significant association between procedure order and the outcomes (all p>0.05). In the off-pump cohort, non-first procedures were associated with an increased number of AEC (adjusted rate ratio 1.29, 95% CI 1.13 to 1.47, p<0.001), myocardial infarction (adjusted OR (ORadj) 1.43, 95% CI 1.13 to 1.81, p=0.003) and stroke (ORadj 1.73, 95% CI 1.18 to 2.53, p=0.005) compared with first procedures. These increases were only found to be statistically significant when the procedure was performed by surgeons with <20 years' practice or surgeons with a preindex volume <700 cases. CONCLUSIONS For a technically challenging surgical procedure like off-pump CABG, prior workload adversely affected patient outcomes.
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Affiliation(s)
- Danwei Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dachuan Gu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chenfei Rao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Heng Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoting Su
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Sipeng Chen
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hanping Ma
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yan Zhao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Feng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hansong Sun
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- National Health Commission Key Laboratory of Cardiovascular Regenerative Medicine, Fuwai Central-China Hospital, Central-China Branch of National Center for Cardiovascular Diseases, Zhengzhou, People's Republic of China
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Campbell RL, Bridges AJ. Bedtime procrastination mediates the relation between anxiety and sleep problems. J Clin Psychol 2023; 79:803-817. [PMID: 36169391 DOI: 10.1002/jclp.23440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 05/08/2022] [Accepted: 08/23/2022] [Indexed: 11/12/2022]
Abstract
The prevalence of sleep problems is high in primary care patients and in anxious individuals. This study assessed whether total sleep time and bedtime procrastination mediated the association between anxiety and sleep problems. We predicted higher anxiety would be negatively associated with total sleep time and positively associated with bedtime procrastination and sleep problems, and these variables would statistically mediate the association between anxiety and sleep problems. Participants were 308 adult primary care patients, predominantly female (non-Hispanic White = 158, Latinx = 111, mean age = 33.30), who initiated behavioral health services at an integrated primary care clinic. Patients completed a questionnaire regarding psychological health and sleep behaviors. Using structural equation modeling, we found higher anxiety related to higher sleep problems, partially mediated by bedtime procrastination but not total sleep time. This study highlights related factors like anxiety and prebedtime behaviors that may be effective treatment targets for sleep challenges.
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Affiliation(s)
- Rebecca L Campbell
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | - Ana J Bridges
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
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Petitta L, Probst TM, Ghezzi V, Barbaranelli C. The impact of emotional contagion on workplace safety: Investigating the roles of sleep, health, and production pressure. CURRENT PSYCHOLOGY 2023; 42:2362-2376. [PMID: 33758486 PMCID: PMC7972334 DOI: 10.1007/s12144-021-01616-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 12/01/2022]
Abstract
Using emotional contagion theory and the Job Demands-Resources model as a theoretical foundation, we tested the proposition that higher levels of contagion of anger (i.e., a demand) vs. higher levels of contagion of joy (i.e., a resource) will be associated respectively with more vs. fewer sleep disturbances and health problems, which in turn are related to more workplace accidents and injuries. Moreover, we examined the moderating impact of production pressure (i.e., a contextual demand) on the relationship between emotional contagion and employee poor sleep and health. Data from 1000 employees in Italy showed that the conditional indirect effects of contagion of anger, but not of joy, on accidents and injuries via sleep and health problems were intensified as levels of production pressure increased. Furthermore, contagion of anger was positively associated with both sleep disturbances and health problems whereas contagion of joy was negatively related to only sleep disturbances. These findings suggest that the effect of anger that employees absorb during social interactions at work likely persists when coming at home and represents an emotional demand that impairs the physiological functions that regulate restorative sleep and energies recharging; and, this effect is even stronger among employees who perceived higher levels of organizational production pressure.
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Affiliation(s)
- Laura Petitta
- Department of Psychology, Sapienza University of Rome, Via dei Marsi, 78, 00185 Rome, Italy
| | - Tahira M. Probst
- Washington State University Vancouver, 14204 NE Salmon Creek Avenue, Vancouver, WA 98686-9600 USA
| | - Valerio Ghezzi
- Department of Psychology, Sapienza University of Rome, Via dei Marsi, 78, 00185 Rome, Italy
| | - Claudio Barbaranelli
- Department of Psychology, Sapienza University of Rome, Via dei Marsi, 78, 00185 Rome, Italy
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Zhang X, Huo D, Meng S, Li J, Cai Z. Spillover Effect of the Internet on Trade Performance Based on a Vision of the Public's Sleep Health: A Spatial Study of the Global Network. Front Public Health 2022; 9:806694. [PMID: 35096752 PMCID: PMC8793007 DOI: 10.3389/fpubh.2021.806694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
This is the first study to analyze the spatial spillover effect of the internet on trade performance based on a vision of the public's sleep health. The internet's effect on trade performance has been enhanced in a new economy consisting of larger global markets. An overall improvement in health gradually impacts economic development. In this study, hierarchical modeling is applied to reveal the effect of the internet on trade performance at a fundamental level, and the effect of sleep health on trade performance at general level. The global network is structured by a spatial weight matrix based on the Mahalanobis distance of the internet and sleep health. Furthermore, spatial autoregressive modeling is applied to study the effect of the spatial weight matrix based on the Mahalanobis distance matrix of the internet and sleep health on trade performance. The spatial Durbin modeling is applied to further analyze the interaction effect of the spatial weight matrix and countries' factors on trade performance. It was found that the internet has a positive effect on trade performance, and good sleep health can be helpful to the spillover effect of the internet on trade performance. The interaction of the spatial weight matrix and gross domestic product (GDP) can further enhance the effect. This research can assist global managers to further understand the spatial spillover effect of the internet on trade performance based on a vision of the public's sleep health.
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Affiliation(s)
| | - Da Huo
- School of International Trade and Economics, Central University of Finance and Economics, Beijing, China
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Schwartz LP, Devine JK, Hursh SR, Davis JE, Smith M, Boyle L, Fitzgibbons SC. Addressing fatigue in medical residents with biomathematical fatigue modeling. J Occup Health 2021; 63:e12267. [PMID: 34390073 PMCID: PMC8363908 DOI: 10.1002/1348-9585.12267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/27/2023] Open
Abstract
Fatigue in resident physicians has been identified as a factor that contributes to burnout and a decline in overall wellbeing. Fatigue risk exists because of poor sleep habits and demanding work schedules that have only increased due to the COVID‐19 pandemic. At this time, it is important not to lose sight of how fatigue can impact residents and how fatigue risk can be mitigated. While fatigue mitigation is currently addressed by duty hour restrictions and education about fatigue, Fatigue Risk Management Systems (FRMSs) offer a more comprehensive strategy for addressing these issues. An important component of FRMS in other shiftwork industries, such as aviation and trucking, is the use of biomathematical models to prospectively identify fatigue risk in work schedules. Such an approach incorporates decades of knowledge of sleep and circadian rhythm research into shift schedules, taking into account not just duty hour restrictions but the temporal placement of work schedules. Recent research has shown that biomathematical models of fatigue can be adapted to a resident physician population and can help address fatigue risk. Such models do not require subject matter experts and can be applied in graduate medical education program shift scheduling. It is important for graduate medical education program providers to consider these alternative methods of fatigue mitigation. These tools can help reduce fatigue risk and may improve wellness as they allow for a more precise fatigue management strategy without reducing overall work hours.
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Affiliation(s)
| | | | - Steven R Hursh
- Institutes for Behavior Resources, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan E Davis
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, USA
| | - Mark Smith
- MedStar Institute for Innovation, Washington, DC, USA
| | - Lisa Boyle
- MedStar Georgetown University Hospital, Washington, DC, USA
| | - Shimae C Fitzgibbons
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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10
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Weinstein DF, Choi JG, Mercaldo ND, Stump NN, Paras ML, Berube RA, Hur C. Is Resident-Driven Inpatient Care More Expensive? Challenging a Long-Held Assumption. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1205-1212. [PMID: 33496432 DOI: 10.1097/acm.0000000000003939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The financial impact of graduate medical education (GME) on teaching hospitals remains poorly understood, while calls for increased federal support continue alongside legislative threats to reduce funding. Despite studies suggesting that residents are more "economical" than alternative providers, GME is widely believed to be an expensive investment. Assumptions that residents increase the cost of patient care have persisted in the absence of convincing evidence to the contrary. Thus, the authors sought to examine resident influence on patient care costs by comparing costs between a resident-driven service (RS) and a nonresident-covered service (NRS), with attention to clinical outcomes and how potential cost differences relate to the utilization of resources, length of stay (LOS), and other factors. METHOD This prospective study compared costs and clinical outcomes of internal medicine patients admitted to an RS versus an NRS at Massachusetts General Hospital (July 1, 2016-June 30, 2017). Total variable direct costs of inpatient admission was the primary outcome measure. LOS; 30-day readmission rate; utilization related to diagnostic radiology, pharmaceuticals, and clinical labs; and other outcome measures were also compared. Linear regression models quantified the relationship between log-transformed variable direct costs and service. RESULTS Baseline characteristics of 5,448 patients on the 2 services (3,250 on an RS and 2,198 on an NRS) were similar. On an RS, patient care costs were slightly less and LOS was slightly shorter than on an NRS, with no significant differences in hospital mortality or 30-day readmission rate detected. Resource utilization was comparable between the services. CONCLUSIONS These findings undermine long-held assumptions that residents increase the cost of patient care. Though not generalizable to ambulatory settings or other specialties, this study can help inform hospital decision making around sponsorship of GME programs, especially if federal funding for GME remains capped or is subject to additional reductions.
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Affiliation(s)
- Debra F Weinstein
- D.F. Weinstein is vice president, Graduate Medical Education, Mass General Brigham, and associate professor of medicine, Harvard Medical School, Boston, Massachusetts
| | - Jin G Choi
- J.G. Choi is a second-year medical student, University of Chicago Pritzker School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-8517-8374
| | - Nathaniel D Mercaldo
- N.D. Mercaldo is statistician, Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, and instructor of radiology, Harvard Medical School, Boston, Massachusetts
| | - Natalie N Stump
- N.N. Stump is a fourth-year medical student, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Molly L Paras
- M.L. Paras is infectious disease fellowship director, Mass General Brigham, and instructor of medicine, Harvard Medical School, Boston, Massachusetts
| | - Rhodes A Berube
- R.A. Berube is senior administrative director for clinical operations, Massachusetts General Hospital, Boston, Massachusetts
| | - Chin Hur
- C. Hur is director, Healthcare Innovations Research and Evaluation, and professor of medicine, Columbia University, New York, New York
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11
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Harris JD. Editorial Commentary: Arthrosomnology and the Solution to Coxalgia Somnia: Arthroscopic Hip Surgeons and Patients Increasingly Appreciate the Role of Sleep as Good Medicine. Arthroscopy 2021; 37:879-881. [PMID: 33673968 DOI: 10.1016/j.arthro.2020.12.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 02/02/2023]
Abstract
It is increasingly recognized that a variety of musculoskeletal disorders significantly influence sleep. In individuals with sleep dysfunction caused by hip pain (coxalgia somnia) from osteoarthritis, total hip arthroplasty has reliably improved pain and sleep quality in most patients. In nonarthritic, nondysplastic individuals with femoroacetabular impingement syndrome caused by cam and/or pincer morphology and labral tears, hip arthroscopy has similarly reliably improved pain and function in most patients. In addition, there is now early short-term evidence showing significant improvements in both sleep quantity and quality in most patients after arthroscopic hip preservation surgery. Integrating the realms of hip arthroscopy and sleep medicine, known as arthrosomnology, there are dozens of subjective patient-reported and objective clinician-measured outcomes available to analyze the impact of interventions. The Pittsburgh Sleep Quality Index is the most common subjective questionnaire used in orthopaedic surgery literature. Integrating the realms of wearable technology (fitness trackers, smart watches) and machine learning and artificial intelligence has incredible potential to collect immense volumes of accurate sleep "big data."
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12
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Finn KM, Halvorsen AJ, Chaudhry S, Desai S, Dupras D, Reddy S, Wahi-Gururaj S, Willett L, Zaas AK. Does Increased Schedule Flexibility Lead to Change? A National Survey of Program Directors on 2017 Work Hours Requirements. J Gen Intern Med 2020; 35:3205-3209. [PMID: 32869195 PMCID: PMC7661583 DOI: 10.1007/s11606-020-06109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The learning and working environment for resident physicians shifted dramatically over the past two decades, with increased focus on work hours, resident wellness, and patient safety. Following two multi-center randomized trials comparing 16-h work limits for PGY-1 trainees to more flexible rules, the ACGME implemented new flexible work hours standards in 2017. OBJECTIVE We sought to determine program directors' (PDs) support for the work hour changes and programmatic response. DESIGN In 2017, US Internal Medicine PDs were surveyed about their degree of support for extension of PGY-1 work hour limits, whether they adopted the new maximum continuous work hours permitted, and reasons for their decisions. KEY RESULTS The response rate was 70% (266/379). Fifty-seven percent of PDs (n = 151) somewhat/strongly support the new work hour rules for PGY-1 residents, while only 25% of programs (N = 66) introduced work periods greater than 16-h on any rotation. Higher rates of adopting change were seen in PDs who strongly/somewhat supported the change (56/151 [37%], P < 0.001), had tenure of 6+ years (33/93 [35%], P = 0.005), were of non-general internal medicine subspecialty (30/80 [38%], P = 0.003), at university-based programs (35/101 [35%], P = 0.009), and with increasing number of approved positions (< 38, 10/63 [16%]; 38-58, 13/69 [19%]; 59-100, 15/64 [23%]; > 100, 28/68 [41%], P = 0.005). Areas with the greatest influence for PDs not extending work hours were the 16-h rule working well (56%) and risk to PGY1 well-being (47%). CONCLUSIONS Although the majority of PDs support the ACGME 2017 work hours rules, only 25% of programs made immediate changes to extend hours. These data reveal that complex, often competing, forces influence PDs' decisions to change trainee schedules.
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Affiliation(s)
- Kathleen M Finn
- Internal Medicine Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Andrew J Halvorsen
- Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Saima Chaudhry
- Office of Academic Affairs, Memorial Healthcare System, Hollywood, FL, USA
| | - Sanjay Desai
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Denise Dupras
- Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shalini Reddy
- Internal Medicine Residency Program, John H. Stroger Hospital of Cook County Health, Chicago, IL, USA
| | - Sandhya Wahi-Gururaj
- Internal Medicine Residency, Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Lisa Willett
- Tinsley Harrison Internal Medicine Residency, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aimee K Zaas
- Internal Medicine Residency Program, Duke University School of Medicine, Durham, NC, USA
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Chang RE, Yu TH, Shih CL. The number and composition of work hours for attending physicians in Taiwan. Sci Rep 2020; 10:14934. [PMID: 32913272 PMCID: PMC7483534 DOI: 10.1038/s41598-020-71873-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022] Open
Abstract
Long work hours among physicians is a worldwide issue in the healthcare arena. Previous studies have largely focused on the work hours of resident physicians rather than those of attending physicians. The purpose of this study was to investigate total work hours and the composition of those work hours for attending physicians across different hospital settings and across different medical specialties through a nationwide survey. This included examining differences in physician workload and its composition with respect to different hospital characteristics, and grouping medical specialties according to the work similarities. A cross-sectional self-reported nationwide survey was conducted from June to September of 2018, and the two questionnaires were distributed to all accredited hospitals in Taiwan. The number of physician work hours in different types of duty shifts were answered by medical specialty in each surveyed hospital. Each medical specialty in a hospital filled only one response for its attending physicians. The findings reveal that the average total work hours per week of an attending physician is around 69.1 h, but the total work hours and their composition of different duty shifts varied among hospital accreditation levels, geographic locations, emergency care responsibilities, and medical specialties. Because of the variance in the number and composition of attending physicians' work hours, adjusting physician work hours to a reasonable level will be a major challenge for health authority and hospital managers.
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Affiliation(s)
- Ray-E Chang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Institute of Health Policy and Management, National Taiwan University, Room 639, No 17, Hsu-Chow Road, Taipei, 100, Taiwan.
| | - Tsung-Hsien Yu
- Department of Health Care Management, National Taipei University of Nursing and Science, Taipei, Taiwan
| | - Chung-Liang Shih
- Department of Medical Affairs, Ministry of Health and Welfare, Taipei, Taiwan
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Schroeppel TJ, Sharpe JP, Magnotti LJ, Weinberg JA, Croce MA, Fabian TC. How to Increase the Burden on Trauma Centers: Implement the 80-hour Work Week. Am Surg 2020. [DOI: 10.1177/000313481408000719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 80-hour week was implemented in 2003 to improve outcomes and limit errors. We hypothesize that there has been no change in outcomes postimplementation of the restrictions. Outcomes were queried from the trauma registry from 1997 to 2002 (PRE) and 2004 to 2009 (POST). Primary outcomes were mortality, intensive care unit length of stay (ICU LOS), and length of stay (LOS). Patients were stratified based on demographics, blood pressure, heart rate, and injury severity (Injury Severity Score, Glasgow Coma Score, base deficit). Outcomes were then compared PRE with POST. A total of 41,770 patients were admitted during the study period. The mean age was 38 years with most being male (73%) and blunt mechanism (78%). Although patients admitted in the POST period had a slightly higher blood pressure, they were older and had higher injury severity. ICU LOS, LOS, self-pay, and mortality were higher in the POST period. After adjusted analysis, admission in the POST period was no longer a predictor of mortality (odds ratio, 1.02; confidence interval, 0.92 to 1.14). Whereas patients were more slightly more injured in the POST period, the adjusted analysis shows no difference in mortality and both a longer LOS and ICU LOS. Whether the increase is the result of more severe injury in the POST period or less efficient disposition remains to be elucidated. This study adds to the mounting evidence that the implementation of the limits on work hours does not lead to better outcomes.
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Affiliation(s)
- Thomas J. Schroeppel
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - John P. Sharpe
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Louis J. Magnotti
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jordan A. Weinberg
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Martin A. Croce
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Timothy C. Fabian
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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Resident Working Hour Restrictions Increased the Workload of the Medical Emergency Team: A Retrospective Observational Study. J Patient Saf 2020; 15:e94-e97. [PMID: 31764533 DOI: 10.1097/pts.0000000000000629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Restrictions to residents' working hours have been shown to increase the workload of other medical resources; few studies have measured the effects on medical emergency teams (METs). OBJECTIVES This study evaluated how limiting residents' working hours affected the workload of MET in a pulmonology unit. METHODS This retrospective observational study analyzed MET activity during periods before and after we limited the working hours of residents in our pulmonary unit to 88 h/wk: Period 1, March 2014 to February 2015; and Period 2, March 2015 to February 2016. Medical emergency team activities, dose (activations/1000 admissions), intensive care unit transfers, and mortality were compared between the two periods for weekdays and for weekends and holidays. RESULTS There were no significant differences between the two periods in MET dose (85.0 in Period 1 versus 91.3 in Period 2, P = 0.675), intensive care unit transfers (P = 0.828), 30-day mortality (P = 0.701), and 60-day mortality (P = 0.531). However, some activities increased significantly or near significantly in Period 2, including portable echocardiography (P < 0.001), arterial line insertion (P = 0.034), mechanical ventilation (P = 0.063), and fluid therapy (P = 0.220). These increases were greater for weekends and holidays than for weekdays. CONCLUSIONS Since December 2017, a specific law for improving the training environment and status of residents has been implemented and applied at all hospitals in Korea. This legal restriction to working hours raises concerns regarding other medical personnel and system improvements to ensure patient safety and care continuity.
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Uslaner JM, Herring WJ, Coleman PJ. The Discovery of Suvorexant: Lessons Learned That Can Be Applied to Other CNS Drug Development Efforts. ACS Pharmacol Transl Sci 2020; 3:161-168. [PMID: 32259095 PMCID: PMC7088936 DOI: 10.1021/acsptsci.9b00110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Indexed: 11/29/2022]
Abstract
The development of therapeutics for central nervous system (CNS) disorders has many challenges that result in low probability of success and longer-than-typical development timelines. Suvorexant (Belsomra), the first dual orexin receptor antagonist used for insomnia, was approved by the United States Food and Drug Administration ∼10 years after the initial high-throughput screen was conducted to identify orexin receptor antagonists. What accounted for this success and speed? Here we suggest that this program was unique and set up for success by (1) having a robust and high-throughput pharmacodynamic readout that was translatable across species, including humans, (2) a well-validated target with a defined product profile, resulting in a highly energized team with a can-do attitude, and (3) a highly executable and streamlined clinical strategy. The utility of Belsomra for insomnia, as well as other neurological and psychiatric diseases, continues to be explored, most recently for insomnia associated with Alzheimer's disease.
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Affiliation(s)
- Jason M. Uslaner
- Discovery Neuroscience, Clinical Neuroscience, and Chemistry, Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - William J. Herring
- Discovery Neuroscience, Clinical Neuroscience, and Chemistry, Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
| | - Paul J. Coleman
- Discovery Neuroscience, Clinical Neuroscience, and Chemistry, Merck & Co., Inc., Kenilworth, New Jersey 07033, United States
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Amez S, Vujić S, Soffers P, Baert S. Yawning while scrolling? Examining gender differences in the association between smartphone use and sleep quality. J Sleep Res 2020; 29:e12971. [PMID: 31919946 DOI: 10.1111/jsr.12971] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 12/20/2022]
Abstract
The negative consequences of deteriorated sleep have been widely acknowledged. Therefore, research on the determinants of poor sleep is crucial. A factor potentially contributing to poor sleep is the use of a smartphone. This study aims to measure the association between overall daily smartphone use and both sleep quality and sleep duration. To this end, we exploit data on 1,889 first-year university students. Compared with previous research we control for a large set of observed confounding factors. Higher overall smartphone use is associated with lower odds of experiencing a good sleep. In addition, we explore heterogeneous differences by socioeconomic factors not yet investigated. We find that the negative association between smartphone use and sleep quality is mainly driven by female participants.
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Affiliation(s)
| | - Sunčica Vujić
- University of Antwerp, Antwerp, Belgium.,University of Bath, Bath, UK
| | | | - Stijn Baert
- Ghent University, Ghent, Belgium.,University of Antwerp, Antwerp, Belgium.,Research Foundation - Flanders, Brussels, Belgium.,Université catholique de Louvain, Louvain-la-Neuve, Belgium.,IZA, Bonn, Germany.,GLO, Maastricht, The Netherlands.,IMISCOE, Rotterdam, The Netherlands
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Lauer CI, Shabahang MM, Restivo B, Lane S, Hayek S, Dove J, Ellison HB, Pica E, Ryer EJ. The Value of Surgical Graduate Medical Education (GME) Programs Within An Integrated Health Care System. JOURNAL OF SURGICAL EDUCATION 2019; 76:e173-e181. [PMID: 31466894 DOI: 10.1016/j.jsurg.2019.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/06/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Surgical graduate medical education (GME) programs add both significant cost and complexity to the mission of teaching hospitals. While expenses tied directly to surgical training programs are well tracked, overall cost-benefit accounting has not been performed. In this study, we attempt to better define the costs and benefits of maintaining surgical GME programs within a large integrated health system. DESIGN We examined the costs, in 2018 US dollars, associated with the surgical training programs within a single health system. Total health system expenses were calculated using actual and estimated direct GME expenses (salary, benefits, supplies, overhead, and teaching expenses) as well as indirect medical education (IME) expenses. IME expenses for each training program were estimated by using both Medicare percentages and the Medicare Payment Advisor Commission study. The projected cost to replace surgical trainees with advanced practitioners or hospitalists was obtained through interviews with program directors and administrators and was validated by our system's business office. SETTING A physician lead, integrated, rural health system consisting of 8 hospitals, a medical school and a health insurance company. PARTICIPANTS GME surgical training programs within a single health system's department of surgery. RESULTS Our health system's department of surgery supports 8 surgical GME programs (2 general surgery residencies along with residencies in otolaryngology, ophthalmology, oral-maxillofacial surgery, urology, pediatric dentistry, and vascular surgery), encompassing 89 trainees. Trainees work an average of 64.4 hours per week. Total health system cost per resident ranged from $249,657 to $516,783 based on specialty as well as method of calculating IME expenses. After averaging program costs and excluding IME and overhead expenses, we estimated the average annual cost per trainee to be $84,171. We projected that replacing our surgical trainees would require hiring 145 additional advanced practitioners at a cost of $166,500 each per year, or 97 hospitalists at a cost of $346,500 each per year. Excluding overhead, teaching and IME expenses, these replacements would cost the health system an estimated additional $16,651,281 or $26,119,281 per year, respectively. CONCLUSIONS Surgical education is an integral part of our health system and ending surgical GME programs would require large expansion of human resources and significant additional fiscal capital.
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Affiliation(s)
- Claire I Lauer
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | | | - Brian Restivo
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Samantha Lane
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Sarah Hayek
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - James Dove
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Halle B Ellison
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Erin Pica
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Evan J Ryer
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania.
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Jena AB, Farid M, Blumenthal D, Bhattacharya J. Association of residency work hour reform with long term quality and costs of care of US physicians: observational study. BMJ 2019; 366:l4134. [PMID: 31292124 PMCID: PMC6619440 DOI: 10.1136/bmj.l4134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine whether 30 day mortality, 30 day readmissions, and inpatient spending vary according to whether physicians were exposed to work hour reforms during their residency. DESIGN Retrospective observational study. SETTING US Medicare. PARTICIPANTS 20% random sample (n=485 685) of Medicare beneficiaries aged 65 years or more admitted to hospital and treated by a general internist during 2000-12. MAIN OUTCOME MEASURES 30 day mortality, 30 day readmissions, and inpatient Medicare Part B spending among patients treated by first year internists who were fully exposed to the 2003 Accreditation Council for Graduate Medical Education (ACGME) work hour reforms during their residency (completed residency after 2006) compared with first year internists with partial or no exposure to reforms (completed residency before 2006). Senior internists not exposed to reforms during their residency served as a control group (10th year internists) for general trends in hospital care: a difference-in-difference analysis. RESULTS Exposure of physicians to work hour reforms during their residency was not associated with statistically significant differences in 30 day mortality, 30 day readmissions, or inpatient spending. Among 485 685 hospital admissions, 30 day mortality rates during 2000-06 and 2007-12 for patients of first year internists were 10.6% (12 567 deaths/118 014 hospital admissions) and 9.6% (13 521/140 529), respectively, and for 10th year internists were 11.2% (11 018/98 811) and 10.6% (13 602/128 331), for an adjusted difference-in-difference effect of -0.1 percentage points (95% confidence interval -0.8% to 0.6%, P=0.68). 30 day readmission rates for first year internists during 2000-06 and 2007-12 were 20.4% (24 074/118 014) and 20.4% (28 689/140 529), respectively, and for 10th year internists were 20.1% (19 840/98 811) and 20.5% (26 277/128 331), for an adjusted difference-in-difference effect of 0.1 percentage points (-0.9% to 1.1%, P=0.87). Medicare Part B inpatient spending for first year internists during 2000-06 and 2007-12 was $1161 (£911; €1024) and $1267 per hospital admission, respectively, and for 10th year internists was $1331 and $1599, for an adjusted difference-in-difference effect of -$46 (95% confidence interval -$94 to $2, P=0.06). CONCLUSIONS Exposure of internists to work hour reforms during their residency was not associated with post-training differences in patient mortality, readmissions, or costs of care.
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Affiliation(s)
- Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
- Massachusetts General Hospital, Boston, MA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
| | - Monica Farid
- Program in Health Policy, Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA
| | - Daniel Blumenthal
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jay Bhattacharya
- National Bureau of Economic Research, Cambridge, MA, USA
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
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Kalani C, Garcia I, Ocegueda-Pacheco C, Varon J, Surani S. The Innovations in Pulmonary Hypertension Pathophysiology and Treatment: What are our Options! CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666190117133311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Charlene Kalani
- Bay Area Medical Center, Corpus Christi, Texas, United States
| | - Ismael Garcia
- Dorrington Medical Associates, PA, Houston, Texas, United States
| | | | | | - Salim Surani
- Texas A&M University, College Station, Texas, United States
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Mrdutt MM, Weber RA, Burke LM, Thomas JS, Papaconstantinou HT, Cable CT. Financial Value Analysis of Surgical Residency Programs: An Argument Against Replacement. JOURNAL OF SURGICAL EDUCATION 2018; 75:e150-e155. [PMID: 30100323 DOI: 10.1016/j.jsurg.2018.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/03/2018] [Accepted: 07/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To quantify the replacement cost of patient care provided by surgical residents and build a Graduate Medical Education (GME) value analysis model. DESIGN Our Graduate Medical Education Executive Steering Committee designed a resident replacement cost model, based on patient care hours (adjusted for educational activities and a clinical efficiency factor, differential cost of faculty supervision for residents vs. APPs, and current program financials (revenue minus expenses). Strategic value planning included: academic productivity (local and national conference presentations, book chapters and publications and Senior Staff recruitment and retention. SETTING Department of Surgery at Baylor Scott & White Medical Center, a tertiary institution located in Temple, TX. PARTICIPANTS Our replacement model was applied to a sample 30-position residency program. RESULTS Modeling a 30-position residency program, replacement cost approaches 4.5 million dollars, based on a 1:3 Senior Staff-to-APP replacement ratio. A complete APP replacement complement has a projected cost of 3.1 million dollars, while replacement with Senior Staff approaches 9 million dollars. CONCLUSIONS We present a novel model for residency value analysis allowing for reproducible and standardized results across multiple residency programs. Challenges inherent to GME, such as clinical efficiency and the cost of faculty supervision, are accounted for. Quantifying resident replacement cost and financial value is a powerful tool when discussing institutional workforce planning within the current financial climate of healthcare.
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Affiliation(s)
- M M Mrdutt
- Department of Surgery, Baylor Scott & White Medical Center, Temple Texas.
| | - R A Weber
- Department of Surgery, Baylor Scott & White Medical Center, Temple Texas.
| | - L M Burke
- Office of Academic Finance, Baylor Scott & White Medical Center, Temple Texas.
| | - J S Thomas
- Department of Surgery, Baylor Scott & White Medical Center, Temple Texas.
| | | | - C T Cable
- Graduate Medical Education, Baylor Scott & White Medical Center, Temple, Texas.
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The poverty of theory: Evidence-based medicine and the social contract. J Trauma Acute Care Surg 2018; 85:7-11. [DOI: 10.1097/ta.0000000000001927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chattu VK, Sakhamuri SM, Kumar R, Spence DW, BaHammam AS, Pandi-Perumal SR. Insufficient Sleep Syndrome: Is it time to classify it as a major noncommunicable disease? Sleep Sci 2018; 11:56-64. [PMID: 30083291 PMCID: PMC6056073 DOI: 10.5935/1984-0063.20180013] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/07/2018] [Indexed: 12/16/2022] Open
Abstract
Over the last three to four decades, it has been observed that the average total number of hours of sleep obtained per night by normal individuals have decreased. Concomitantly, global figures indicate that insufficient sleep is associated with serious adverse health and social outcomes. Moreover, insufficient sleep has been linked to seven of the fifteen leading causes of death. Additionally, current evidence suggests that sleep plays a significant role in determining cognitive performance and workplace productivity. There is a great need for a systematic analysis of the economic impact of insufficient sleep, particularly given current evidence that this phenomenon, as well as the poor sleep hygiene practices which produce it, is increasing worldwide. This paper takes the view that health authorities around the world need to raise the general awareness of benefits of sleep. There is considerable scope for research into both the public health impact as well as the macroeconomic consequences of insufficient sleep syndrome (ISS). Additionally, various models which estimate the undiagnosed burden of ISS on the GDP (gross domestic product) are needed to prioritize health issues and to highlight the national policies that are necessary to combat this medical problem. Sleep insufficiency has been declared to be a 'public health epidemic'; therefore, we propose ISS as a potential noncommunicable disease. This review elaborates on this topic further, exploring the causes and consequences of insufficient sleep, and thus providing a perspective on the policies that are needed as well as the research that will be required to support and justify these policies.
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Affiliation(s)
- Vijay Kumar Chattu
- Faculty of Medical Sciences, The University of the West Indies, St.
Augustine, Trinidad & Tobago
| | - Sateesh M. Sakhamuri
- Faculty of Medical Sciences, The University of the West Indies, St.
Augustine, Trinidad & Tobago
| | - Raman Kumar
- President, Academy of Family Physicians of India, New Delhi,
India
| | | | - Ahmed S. BaHammam
- University Sleep Disorders Center, College of Medicine and National
Plan for Science and Technology, King Saud University, Riyadh, Saudi Arabia
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July Syndrome. AORN J 2018; 107:166-168. [PMID: 29341087 DOI: 10.1002/aorn.12000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lichtenstein C, Cora-Bramble D, Ottolini M, Agrawal D. Is There a Return on a Children’s Hospital’s Investment in a Pediatric Residency’s Community Health Track? A Cost Analysis. J Community Health 2017; 43:372-377. [DOI: 10.1007/s10900-017-0433-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fang M, Linson E, Suneja M, Kuperman EF. Impact of adding additional providers to resident workload and the resident experience on a medical consultation rotation. BMC MEDICAL EDUCATION 2017; 17:44. [PMID: 28228099 PMCID: PMC5322644 DOI: 10.1186/s12909-017-0874-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/31/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Excellence in Graduate Medical Education requires the right clinical environment with an appropriate workload where residents have enough patients to gain proficiency in medicine with optimal time for reflection. The Accreditation Council for Graduate Medical Education (ACGME) has focused more on work hours rather than workload; however, high resident workload has been associated with lower resident participation in education and fatigue-related errors. Recognizing the potential risks associated with high resident workload and being mindful of the costs of reducing resident workload, we sought to reduce residents' workload by adding an advanced practice provider (APP) to the surgical comanagement service (SCM) and study its effect on resident satisfaction and perceived educational value of the rotation. METHODS In Fiscal Year (FY) 2014 and 2015, an additional faculty member was added to the SCM rotation. In FY 2014, the faculty member was a staff physician, and in FY 2015, the faculty member was an APP.. Resident workload was assessed using billing data. We measured residents' perceptions of the rotation using an anonymous electronic survey tool. We compared FY2014-2015 data to the baseline FY2013. RESULTS The number of patients seen per resident per day decreased from 8.0(SD 3.3) in FY2013 to 5.0(SD 1.9) in FY2014 (p < 0.001) and 5.7(SD 2.0) in FY2015 (p < 0.001). A higher proportion of residents reported "just right" patient volume (64.4%, 91.7%, 96.7% in FY2013, 2014, 2015 respectively p < 0.001), meeting curricular goals (79.9%, 95.0%, 97.2%, in FY2013, 2014 and 2015 respectively p < 0.001), and overall educational value of the rotation (40.0%, 72.2%, 72.6% in FY2013, 2014, 2015 respectively, p < 0.001). CONCLUSIONS Decreasing resident workload through adding clinical faculty (both staff physician and APPs) was associated with improvements on resident perceived educational value and clinical experience of a medical consultation rotation.
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Affiliation(s)
- Michele Fang
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA USA
- Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Section of Hospital Medicine, Hospital of the University of Pennsylvania, Department of Medicine, Section of Hospital Medicine, 3400 Spruce Street, Maloney Building, 5th floor, Suite 5033, Philadelphia, PA 19104 USA
| | - Eric Linson
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA USA
| | - Manish Suneja
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA USA
| | - Ethan F. Kuperman
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA USA
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Abstract
INTRODUCTION To date, no study has reported on the public's opinion of orthopaedic resident duty-hour requirements (DHR). METHODS A survey was administered to people in orthopaedic waiting rooms and at three senior centers. Responses were analyzed to evaluate seven domains: knowledge of duty hours; opinions about duty hours; attitudes regarding shift work; patient safety concerns; and the effects of DHRs on continuity of care, on resident training, and on resident professionalism. RESULTS Respondents felt that fatigue was unsafe and duty hours were beneficial in preventing resident physician fatigue. They supported the idea of residents working in shifts but did not support shifts for attending physicians. However, respondents wanted the same resident to provide continuity of care, even if that violated DHRs. They were supportive of increasing the length of residency to complete training. DHRs were not believed to affect professionalism. Half of the respondents believed that patient opinion should influence policy on this topic. DISCUSSION Orthopaedic patients and those likely to require orthopaedic care have inconsistent opinions regarding DHRs, making it potentially difficult to incorporate their preferences into policy.
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Jena AB, Schoemaker L, Bhattacharya J. Exposing physicians to reduced residency work hours did not adversely affect patient outcomes after residency. Health Aff (Millwood) 2016; 33:1832-40. [PMID: 25288430 DOI: 10.1377/hlthaff.2014.0318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2003, work hours for physicians-in-training (residents) were capped by regulation at eighty hours per week, leading to the hotly debated but unexplored issue of whether physicians today are less well trained as a result of these work-hour reforms. Using a unique database of nearly all hospitalizations in Florida during 2000-09 that were linked to detailed information on the medical training history of the physician of record for each hospitalization, we studied whether hospital mortality and patients' length-of-stay varied according to the number of years a physician was exposed to the 2003 duty-hour regulations during his or her residency. We examined this database of practicing Florida physicians, using a difference-in-differences analysis that compared trends in outcomes of junior physicians (those with one-year post-residency experience) pre- and post-2003 to a control group of senior physicians (those with ten or more years of post-residency experience) who were not exposed to these reforms during their residency. We found that the duty-hour reforms did not adversely affect hospital mortality and length-of-stay of patients cared for by new attending physicians who were partly or fully exposed to reduced duty hours during their own residency. However, assessment of the impact of the duty-hour reforms on other clinical outcomes is needed.
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Affiliation(s)
- Anupam B Jena
- Anupam B. Jena is an assistant professor of health care policy and medicine at Harvard Medical School and a physician at Massachusetts General Hospital, both in Boston; and a faculty research fellow at the National Bureau of Economic Research, in Cambridge, Massachusetts
| | - Lena Schoemaker
- Lena Schoemaker is a research assistant at the Center for Primary Care and Outcomes Research at Stanford University, in California
| | - Jay Bhattacharya
- Jay Bhattacharya is an associate professor at the Center for Primary Care and Outcomes Research at Stanford University and a research associate at the National Bureau of Economic Research
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Ham PB, Anderton T, Gallaher R, Hyrman M, Simmerman E, Ramanathan A, Fallaw D, Holsten S, Howell CG. Development of Electronic Medical Record-Based “Rounds Report” Results in Improved Resident Efficiency, More Time for Direct Patient Care and Education, and Less Resident Duty Hour Violations. Am Surg 2016. [DOI: 10.1177/000313481608200950] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surgeons frequently report frustration and loss of efficiency with electronic medical record (EMR) systems. Together, surgery residents and a programmer at Augusta University created a rounds report (RR) summarizing 24 hours of vitals, intake/output, labs, and other values for each inpatient that were previously transcribed by hand. The objective of this study was to evaluate the RR's effect on surgery residents. Surgery residents were queried to assess the RR's impact. Outcome measures were time spent preparing for rounds, direct patient care time, educational activity time, rates of incorrect/incomplete data on rounds, and rate of duty hour violations. Hospital wide, 17,200 RRs were generated in the 1-month study. Twenty-three surgery residents participated. Time spent preparing for rounds decreased per floor patient (15.6 ± 3.0 vs 6.0 ± 1.2, P < 0.0001) and per intensive care unit patient (19.9 ± 2.9 vs 7.5 ± 1.2 P < 0.0001). The work day spent in direct patient care increased from 45.1 ± 5.6 to 54.0 ± 5.7 per cent ( P = 0.0044). Educational activity time increased from 35.2 ± 5.4 to 54.7 ± 7.1 minutes per resident per day ( P = 0.0004). Reported duty hour violations decreased 58 per cent ( P < 0.0001). American Board of Surgery in Training exam scores trended up, and estimates of departmental annual financial savings range from $66,598 to $273,141 per year. Significant improvements occur with surgeon designed EMR tools like the RR. Hospitals and EMR companies should pair interested surgeons with health information technology developers to facilitate EMR enhancements. Improvements like RRs can have broad ranging, multidisciplinary impact and should be standard in all EMRs used for inpatient care at academic medical centers.
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Affiliation(s)
- Phillip B. Ham
- Departments of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Toby Anderton
- Departments of Orthopedics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Ryan Gallaher
- Departments of Infectious Disease, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Mike Hyrman
- Departments of Information Technology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Erika Simmerman
- Departments of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Annamalai Ramanathan
- Departments of Family Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - David Fallaw
- Departments of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Steven Holsten
- Departments of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Charles Gordon Howell
- Departments of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
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Schroeppel TJ, Sharpe JP, Magnotti LJ, Weinberg JA, Croce MA, Fabian TC. How to Further Decrease the Efficiency of Care at a Level I Trauma Center: Implement the Amended Resident Work Hours. Am Surg 2015. [DOI: 10.1177/000313481508100719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Work-hour restrictions were amended in 2011 to limit interns to 16 continuous duty hours, essentially requiring a night float system of 12-hour shifts. We hypothesize that there has been no improvement in outcomes after implementation of the amended work-hour restrictions. Outcomes from trauma admissions were queried from the trauma registry from 2009 to 2011 (PRE) and 2011 to 2013 (POST). The primary outcome was mortality with secondary outcomes intensive care unit length of stay (LOS) and LOS. Patients were stratified based on age, mechanism, gender, blood pressure, heart rate, and injury severity (Injury Severity Score, Glasgow Coma Scale, Base Deficit). Outcomes were then compared from admissions PRE to POST. A total of 9178 patients were included in the study population. The mean age was 42 with most being male (72%) and blunt mechanism (81%). Patient populations were well matched except patients in the POST period were slightly older (43 vs 42 years; P = 0.01). Intensive care unit LOS and LOS were higher in the POST period. After adjusted analysis, admission in the POST period was not a predictor of mortality (odds ratio 0.857; confidence interval 0.655–1.12). The POST period was an independent predictor for LOS (β = 0.74; P = 0.002). This study adds to the mounting evidence that the implementation of the amended limits on work hours leads to furthermore decreased efficiency of care.
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Affiliation(s)
- Thomas J. Schroeppel
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - John P. Sharpe
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Louis J. Magnotti
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jordan A. Weinberg
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Martin A. Croce
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Timothy C. Fabian
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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Law MP, Orlando E, Baker GR. Organizational interventions in response to duty hour reforms. BMC MEDICAL EDUCATION 2014; 14 Suppl 1:S4. [PMID: 25558915 PMCID: PMC4304281 DOI: 10.1186/1472-6920-14-s1-s4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Changes in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations. This paper examines, and assesses the impact of, organizational interventions that were a direct response to these duty hour reforms. METHODS The academic literature was searched through the SCOPUS database using the search terms "resident duty hours" and "European Working Time Directive," together with terms related to organizational factors. The search was limited to English-language literature published between January 2003 and January 2012. Studies were included if they reported an organizational intervention and measured an organizational outcome. RESULTS Twenty-five articles were included from the United States (n=18), the United Kingdom (n=5), Hong Kong (n=1), and Australia (n=1). They all described single-site projects; the majority used post-intervention surveys (n=15) and audit techniques (n=4). The studies assessed organizational measures, including relationships among staff, work satisfaction, continuity of care, workflow, compliance, workload, and cost. Interventions included using new technologies to improve handovers and communications, changing staff mixes, and introducing new shift structures, all of which had varying effects on the organizational measures listed previously. CONCLUSIONS Little research has assessed the organizational impact of duty hour reforms; however, the literature reviewed demonstrates that many organizations are using new technologies, new personnel, and revised and innovative shift structures to compensate for reduced resident coverage and to decrease the risk of limited continuity of care. Future research in this area should focus on both micro (e.g., use of technology, shift changes, staff mix) and macro (e.g., culture, leadership support) organizational aspects to aid in our understanding of how best to respond to these duty hour reforms.
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Affiliation(s)
- Madelyn P Law
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Elaina Orlando
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Garg M, Drolet BC, Tammaro D, Fischer SA. Resident duty hours: a survey of internal medicine program directors. J Gen Intern Med 2014; 29:1349-54. [PMID: 24913004 PMCID: PMC4175662 DOI: 10.1007/s11606-014-2912-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 02/02/2014] [Accepted: 05/14/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented new Common Program Requirements to regulate duty hours of resident physicians, with three goals: improved patient safety, quality of resident education and quality of life for trainees. We sought to assess Internal Medicine program director (IMPD) perceptions of the 2011 Common Program Requirements in July 2012, one year following implementation of the new standards. METHODS A cross-sectional study of all IMPDs at ACGME-accredited programs in the United States (N = 381) was performed using a 32-question, self-administered survey. Contact information was identified for 323 IMPDs. Three individualized emails were sent to each director over a 6-week period, requesting participation in the survey. Outcomes measured included approval of duty hours regulations, as well as perceptions of changes in graduate medical education and patient care resulting from the revised ACGME standards. RESULTS A total of 237 surveys were returned (73% response rate). More than half of the IMPDs (52%) reported "overall" approval of the 2011 duty hour regulations, with greater than 70% approval of all individual regulations except senior resident daily duty periods (49% approval) and 16-hour intern shifts (17% approval). Although a majority feel resident quality of life has improved (55%), most IMPDs believe that resident education (60%) is worse. A minority report that quality (8%) or safety (11%) of patient care has improved. CONCLUSION One year after implementation of new ACGME duty hour requirements, IMPDs report overall approval of the standards, but strong disapproval of 16-hour shift limits for interns. Few program directors perceive that the duty hour restrictions have resulted in better care for patients or education of residents. Although resident quality of life seems improved, most IMPDs report that their own workload has increased. Based on these results, the intended benefits of duty hour regulations may not yet have been realized.
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Affiliation(s)
- Megha Garg
- Department of Medicine, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy St, JB 0100, Providence, RI, 02903, USA,
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Jackson JB, Huntington WP, Frick SL. Assessing the Value of Work Done by an Orthopedic Resident During Call. J Grad Med Educ 2014; 6:567-70. [PMID: 26279786 PMCID: PMC4535225 DOI: 10.4300/jgme-d-13-00370.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/17/2014] [Accepted: 03/17/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Medicare funding for graduate medical education may be cut in the next federal budget. OBJECTIVE We quantified the value of work that 1 orthopedic surgery resident performs on call and compare it to Medicare educational funding received by the hospital for each resident. METHODS A single orthopedic resident's on-call emergency department and inpatient consults were collected during a 2-year call period at a large, tertiary, level-1 trauma center. Patient charts were reviewed; ICD-9 codes, evaluation and management, and procedural treatment were recorded. Codes were converted into work relative value units. The number of work relative value units was multiplied by the 2012 Medicare rate of $34.03 per relative value units to calculate the monetary value of resident work. RESULTS Of 120 resident call shifts, 115 call sheets (95.8%) were available for review, and 1160 patients were seen (average = 10.09 consults/call). A total of 4688 work relative value units were generated (average = 40.76 per night), and the total dollar value generated was $159,561 ($1,387 per call) during the 2 years of call (average = $79,780 annually). Evaluation and management codes generated 2340 work relative value units, with a calculated dollar amount of $79,648, and procedural codes generated 2348 work relative value units, with a calculated dollar amount of $79,913. CONCLUSIONS Our institution estimated Medicare direct medical education support per resident at $40,000/y, and total funding was $130,000/resident. At our tertiary care institution, the unbilled work of 1 orthopedic resident on call amounts to more than 60% of Medicare direct medical education and indirect medical education funding annually.
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George BP, Probasco JC, Dorsey ER, Venkatesan A. Impact of 2011 resident duty hour requirements on neurology residency programs and departments. Neurohospitalist 2014; 4:119-26. [PMID: 24982715 DOI: 10.1177/1941874413518640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In 2011, the Accreditation Council on Graduate Medical Education (ACGME) redefined resident duty hour requirements by reducing in-hospital duty hour requirements for residents in an effort to improve patient care, resident well-being, and resident education. We sought to determine the cost of adoption based on changes made by neurology residency programs and departments due to these requirements. METHODS We surveyed department chairs or residency program directors at 123 ACGME-accredited US adult neurology training programs on programmatic changes and resident expansion, hiring practices, and development of new computer-based resources in direct response to the 2011 ACGME duty hour requirements. Using data from publicly available resources, we estimated respondents' financial cost of adoption. RESULTS In all, 63 responded (51% response rate); 76% were program directors. The most common changes implemented by programs were adding night float systems (n = 31; 49%) and increasing faculty responsibility (n = 26; 41%). In direct response to the requirements, 21 programs applied to ACGME for 40 additional residents, 29 of which were fully covered by institutional funds. In direct response to the requirements, nearly half of the departments (n = 26) hired individuals for a total of 80 hires (or 64 full-time equivalents), most commonly mid-level practitioners. The total estimated cost to responding departments was US $12.7 million or US $201,000 per department annually. When projecting expenses of planned changes for the following year, costs increased to US $360,000 per department, with 5-year costs exceeding US $1 million. CONCLUSIONS The most recent restriction on resident duty hours comes at substantial cost to neurology departments and residency programs.
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Affiliation(s)
- Benjamin P George
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - John C Probasco
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Arun Venkatesan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Block L, Jarlenski M, Wu AW, Feldman L, Conigliaro J, Swann J, Desai SV. Inpatient safety outcomes following the 2011 residency work-hour reform. J Hosp Med 2014; 9:347-52. [PMID: 24677678 DOI: 10.1002/jhm.2171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/22/2014] [Accepted: 01/24/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of the 2011 residency work-hour reforms on patient safety is not known. OBJECTIVE To evaluate the association between implementation of the 2011 reforms and patient safety outcomes at a large academic medical center. DESIGN Observational study using difference-in-differences estimation strategy to evaluate whether safety outcomes improved among patients discharged from resident and hospitalist (nonresident) services before (2008-2011) and after (2011-2012) residency work-hour changes. PATIENTS All adult patients discharged from general medicine services from July 2008 through June 2012. MEASUREMENTS Outcomes evaluated included length of stay, 30-day readmission, intensive care unit (ICU) admission, inpatient mortality, and presence of Maryland Hospital Acquired Conditions. Independent variables included time period (pre- vs postreform), resident versus hospitalist service, patient age at admission, race, gender, and case mix index. RESULTS Patients discharged from the resident services in the postreform period had higher likelihood of an ICU stay (5.7% vs 4.5%, difference 1.4%; 95% confidence interval [CI]: 0.5% to 2.2%), and lower likelihood of 30-day readmission (17.2% vs 20.1%, difference 2.8%; 95 % CI: 1.3 to 4.3%) than patients discharged from the resident services in the prereform period. Comparing pre- and postreform periods on the resident and hospitalist services, there were no significant differences in patient safety outcomes. CONCLUSIONS In the first year after implementation of the 2011 work-hour reforms relative to prior years, we found no change in patient safety outcomes in patients treated by residents compared with patients treated by hospitalists. Further study of the long-term impact of residency work-hour reforms is indicated to ensure improvement in patient safety.
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Affiliation(s)
- Lauren Block
- Division of General Internal Medicine, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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The effect of new duty hours on resident academic performance and adult resuscitation outcomes. Am J Med 2014; 127:337-42. [PMID: 24355355 DOI: 10.1016/j.amjmed.2013.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 12/11/2013] [Accepted: 12/11/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND From July 2011, the Accreditation Council for Graduate Medical Education implemented new resident duty hours throughout the US. This study aimed to determine whether changes to call schedules due to these new duty hours achieved the intended goals of excellent patient care and improved resident learning. METHODS We conducted a retrospective cohort study at an academic hospital. For patient outcomes, we used the hospital registry for code blues and rapid responses to compare the proportion of deaths and transfers to an intensive care unit (July 2010 to June 2011; July 2011 to June 2012). For resident learning, we compared delta percentage scores for annual in-service training examinations (2009 to 2010; 2010 to 2011; 2011 to 2012). RESULTS We recorded 187 code blues and 469 rapid responses during the 2-year period: 48 (7.3%) deaths, 374 (57.0%) transfers to the intensive care unit, and 234 (35.7%) stabilizations on the floor. Of all transfers to the intensive care unit, those due to a code blue decreased after implementation of the new duty hours (36% [63/174] vs 25% [49/200], P = .02; adjusted odds ratio = 0.59; 95% confidence interval, 0.37-0.92). The median (interquartile range) delta percentage scores for annual in-service training examinations decreased significantly from the first time-period (2009 to 2010: 7 [4-11]) to the third time-period (2011 to 2012: 5 [2-8], P = .02). CONCLUSION We observed a reduced proportion of transfers to the intensive care unit with a code blue after implementation of new resident duty hours. Resident academic performance experienced a small but significant decrease in in-service training examination delta percentage score. We need large, multicenter studies to corroborate these findings.
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Dickey CC, Tarnavsky T, Khan I, Panych LP. Decreasing inter-resident conflict by using computer-generated on-call schedules. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2014; 38:213-216. [PMID: 24519802 DOI: 10.1007/s40596-014-0060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 12/04/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Although significant attention has been paid to the number of hours worked by residents, little consideration has been given to how the hours are assigned. This project describes an alternative to having Chief Residents manually create on-call schedules. In order to enhance objectivity and transparency, reduce perceived inequities in the process, and reduce inter-resident conflict, Harvard South Shore Psychiatry Residency Training Program experimented with a computer-generated on-call schedule. METHOD A locally written MATLAB script generated an on-call schedule for academic year (AY) 2012-2013. Measurements to assess the manual scheduling method (from AY 2011-2012) and the computer-generated method included the balance in the total number of hours assigned to individual residents; the number of call switches over two six-month periods; and survey of the residents' perception of fairness of the two scheduling methods and preferences. RESULTS A retrospective analysis of the AY 2011-2012 Chief Resident-generated call schedule found a range of differences of up to 25.8% between total hours assigned to individual residents in a given year. In the AY 2012-2013 computer-generated schedule, the differences in total hours assigned were reduced to a maximum of 6.1%. There were 63% fewer call switches resulting from the computer-generated as compared to the Chief Resident-generated method. Resident survey response rate was 76%. Seventy-seven percent of resident respondents (N = 22) perceived the computer-generated method to be fairer, and 90.9% of residents preferred having a summary table of hours of call per resident. Residents perceived the computer-generated method as resulting in less inter-resident conflict. CONCLUSION Methods for assigning duty hour schedules that are transparent, equitable, and require less Chief involvement may result in perceptions of greater fairness and less inter-resident conflict.
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Affiliation(s)
- Chandlee C Dickey
- VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA,
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Osborne R, Parshuram CS. Delinking resident duty hours from patient safety. BMC MEDICAL EDUCATION 2014; 14 Suppl 1:S2. [PMID: 25561349 PMCID: PMC4304278 DOI: 10.1186/1472-6920-14-s1-s2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Patient safety is a powerful motivating force for change in modern medicine, and is often cited as a rationale for reducing resident duty hours. However, current data suggest that resident duty hours are not significantly linked to important patient outcomes. We performed a narrative review and identified four potential explanations for these findings. First, we question the relevance of resident fatigue in the creation of harmful errors. Second, we discuss factors, including workload, experience, and individual characteristics, that may be more important determinants of resident fatigue than are duty hours. Third, we describe potential adverse effects that may arise from--and, therefore, counterbalance any potential benefits of--duty hour reductions. Fourth, we explore factors that may mitigate any risks to patient safety associated with using the services of resident trainees. In summary, it may be inappropriate to justify a reduction in working hours on the grounds of a presumed linkage between patient safety and resident duty hours. Better understanding of resident-related factors associated with patient safety will be essential if improvements in important patient safety outcomes are to be realized through resident-focused strategies.
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Affiliation(s)
- Roisin Osborne
- Center for Safety Research, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluation Sciences Program, The Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Patient Safety, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Christopher S Parshuram
- Center for Safety Research, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluation Sciences Program, The Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Patient Safety, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Recognition of clinical deterioration: a clinical leadership opportunity for nurse executive. J Nurs Adm 2013; 43:377-81. [PMID: 23892302 DOI: 10.1097/nna.0b013e31829d606a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recognition and avoidance of further clinical deterioration can be termed a critical success factor in every care delivery model. As care resources become more constrained and allocated to the most critical of patients, some patients are being shifted to less intense and costly care settings where continuous physiologic monitoring may not be an option. Nurse executives are facing these complex issues as they work with clinical experts to develop systems of safety in the patient care arena. A systematic review of the literature related to the recognition of clinical deterioration is needed to identify areas for further leadership, research, and practice advancements.
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Tsui KH, Liu CY, Lui JM, Lee ST, Tan RP, Chang PL. Direct observation of procedural skills to improve validity of students' measurement of prostate volume in predicting treatment outcomes. UROLOGICAL SCIENCE 2013. [DOI: 10.1016/j.urols.2012.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Backeris ME, Forte PJ, Beaman ST, Metro DG. Financial Implications of Different Interpretations of ACGME Anesthesiology Program Requirements for Rotations in the Operating Room. J Grad Med Educ 2013; 5:315-9. [PMID: 24404280 PMCID: PMC3693701 DOI: 10.4300/jgme-d-13-00075.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 09/06/2012] [Accepted: 11/07/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) standards for resident education in anesthesiology mandate required rotations including rotations inside the operating room (OR). When residents complete rotations outside the OR, other providers must be used to maintain the OR's clinical productivity. OBJECTIVE WE QUANTIFIED AND COMPARED THE COSTS OF REPLACING RESIDENTS BY USING TWO DIFFERENT WORKING PATTERNS THAT ARE COMPLIANT WITH THE ACGME ANESTHESIOLOGY PROGRAM REQUIREMENTS: (1) the minimum amount of time in the OR, and (2) working the maximum amount of time permitted in the OR. METHODS We calculated resident replacement costs over a 36-month residency period in both a minimum and maximum OR time model. We used a range of Certified Registered Nurse Anesthetist (CRNA) pay scales determined by a local market analysis for cost comparisons. RESULTS Depending on CRNA pay rates, the cost differentials to replace a resident in the OR between the minimum and maximum OR time models ranged from $236,000 to $581,876, assuming a 50-hour resident work week, and $373,400 to $931,001, assuming an 80-hour resident work week. This cost was per resident over the entire 3 years of their residency. CONCLUSIONS Varying the amount of time residents work in the OR (as allowed under ACGME program requirements) has significant financial implications over a 36-month anesthesiology residency. The larger the residency, the more significant will be the impact on the department and sponsoring institution.
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Navathe AS, Silber JH, Small DS, Rosen AK, Romano PS, Even-Shoshan O, Wang Y, Zhu J, Halenar MJ, Volpp KG. Teaching hospital financial status and patient outcomes following ACGME duty hour reform. Health Serv Res 2013; 48:476-98. [PMID: 22862427 PMCID: PMC3626351 DOI: 10.1111/j.1475-6773.2012.01453.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine whether hospital financial health was associated with differential changes in outcomes after implementation of 2003 ACGME duty hour regulations. DATA SOURCES/STUDY SETTING Observational study of 3,614,174 Medicare patients admitted to 869 teaching hospitals from July 1, 2000 to June 30, 2005. STUDY DESIGN Interrupted time series analysis using logistic regression to adjust for patient comorbidities, secular trends, and hospital site. Outcomes included 30-day mortality, AHRQ Patient Safety Indicators (PSIs), failure-to-rescue (FTR) rates, and prolonged length of stay (PLOS). PRINCIPAL FINDINGS All eight analyses measuring the impact of duty hour reform on mortality by hospital financial health quartile, in postreform year 1 ("Post 1") or year 2 ("Post 2") versus the prereform period, were insignificant: Post 1 OR range 1.00-1.02 and Post 2 OR range 0.99-1.02. For PSIs, all six tests showed clinically insignificant effect sizes. The FTR rate analysis demonstrated nonsignificance in both postreform years (OR 1.00 for both). The PLOS outcomes varied significantly only for the combined surgical sample in Post 2, but this effect was very small, OR 1.03 (95% CI 1.02, 1.04). CONCLUSIONS The impact of 2003 ACGME duty hour reform on patient outcomes did not differ by hospital financial health. This finding is somewhat reassuring, given additional financial pressure on teaching hospitals from 2011 duty hour regulations.
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Affiliation(s)
- Amol S Navathe
- Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA 19104, USA.
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McCormick F, Kadzielski J, Evans BT, Landrigan CP, Herndon J, Rubash H. Fatigue optimization scheduling in graduate medical education: reducing fatigue and improving patient safety. J Grad Med Educ 2013; 5:107-11. [PMID: 24404236 PMCID: PMC3613293 DOI: 10.4300/jgme-d-12-00021.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 07/22/2012] [Accepted: 09/26/2012] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Medical error is a major cause of preventable morbidity and mortality. Resident fatigue is likely to be a significant contributor. OBJECTIVES We calculated and compared predicted fatigue impairment in surgical residents on varying schedules by using the validated Sleep, Activity, Fatigue, and Task Effectiveness model and Fatigue Avoidance Scheduling Tool; we identified specific times of day and rotations during which residents were most affected, instituted countermeasures, and measured the predicted response. METHODS We compared 4 scheduling patterns: day shift, trauma shift, night shift, and prework hour restriction Q3 call (or every-third-night call). The dependent variables were mean daily effectiveness while at work and the percentage of time residents worked with critical fatigue impairment (defined as an effectiveness score of less than 70 correlated with an increased risk for error and a blood alcohol content of 0.08). Fatigue countermeasures (ie, a 30-minute nap, eliminating 24-hour shifts) were applied to rotations with significant impairment to determine impairment plasticity. RESULTS CALCULATED MEAN EFFECTIVENESS SCORES AND PERCENTAGE OF TIME SPENT IMPAIRED AT WORK WERE AS FOLLOWS: day shift, 90.3, 0%; trauma shift, 82.0, 7.5%; prework hour restriction Q3 call shift, 80.7, 23%; and night shift, 68.0, 50% (P < .001). Fatigue optimization countermeasures for night shift rotation improved mean daily effectiveness to 87.1 with only 1.9% of time working while impaired (P < .001). CONCLUSIONS There is a significant potential for fatigue impairment in residents, with work schedule a significant factor. Once targeted, fatigue impairment may be minimized with specific countermeasures. Fatigue optimization tools provide data for targeted scheduling interventions, which reduce fatigue and may mitigate medical error.
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Fabricant PD, Dy CJ, Dare DM, Bostrom MP. A narrative review of surgical resident duty hour limits: where do we go from here? J Grad Med Educ 2013; 5:19-24. [PMID: 24404221 PMCID: PMC3613312 DOI: 10.4300/jgme-d-12-00081.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resident duty hour limits have been a point of debate among educators, administrators, and policymakers alike since the Libby Zion case in 1984. Advocates for duty hour limits in the surgical subspecialties cite improvements in patient safety, whereas opponents claim that limiting resident duty hours jeopardizes resident education and preparedness for independent surgical practice. METHODS Using orthopaedic surgery as an example, we describe the historical context of the implementation of the duty hour standards, provide a review of the literature presenting data that both supports and refutes continued restrictions, and outline suggestions for policy going forward that prioritize patient safety while maintaining an enhanced environment for resident education. RESULTS Although patient safety markers have improved in some studies since the implementation of duty hour limits, it is unclear whether this is due to changes in residency training or external factors. The literature is mixed regarding academic performance and trainee readiness during and after residency. CONCLUSION Although excessive duty hours and resident fatigue may have historically contributed to errors in the delivery of patient care, those are certainly not the only concerns. An overall "culture of safety," which includes pinpointing systematic improvements, identifying potential sources of error, raising performance standards and safety expectations, and implementing multiple layers of protection against medical errors, can continue to augment safety barriers and improve patient care. This can be achieved within a more flexible educational environment that protects resident education and ensures optimal training for the next generation of physicians and surgeons.
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Fagan HA. Sixteen Hours, Education, Error, and Cost—Is Enforcing Continuity the Answer? Sleep 2013; 36:165-6. [DOI: 10.5665/sleep.2362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Coupet S, Del Valle J. A case for an international health elective training program during residency: a four-points call for action. TEACHING AND LEARNING IN MEDICINE 2013; 25:266-271. [PMID: 23848335 DOI: 10.1080/10401334.2013.797347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND International Health Electives (IHE) are becoming more popular among graduate training programs. This is likely due to the high demands from graduating medical students who are seeking to have an international health experience during their post-graduate training. Despite the important educational experiences associated with an IHE, this opportunity does not exist in all graduate medical programs and fewer have formal established programs. SUMMARY We are suggesting that graduate training programs are in a unique position to provide such experiences to our future physicians, in turn creating immediate benefits to host nations as well as long-term impacts on our society in the United States. We are proposing Four Points for stakeholders involved in training future physicians to use as they consider designing such opportunities for future trainees. The four points include: residents are capable of providing service to host nations, improve the quality of care to communities in the U.S., foster graduating medical students' global health interests and increase global health mentorship. CONCLUSIONS We hope that addressing these four points will reemphasize the importance of establishing an IHE in all graduate training programs.
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Affiliation(s)
- Sidney Coupet
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Mansukhani MP, Kolla BP, Surani S, Varon J, Ramar K. Sleep deprivation in resident physicians, work hour limitations, and related outcomes: a systematic review of the literature. Postgrad Med 2012; 124:241-9. [PMID: 22913912 DOI: 10.3810/pgm.2012.07.2583] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Extended work hours, interrupted sleep, and shift work are integral parts of medical training among all specialties. The need for 24-hour patient care coverage and economic factors have resulted in prolonged work hours for resident physicians. This has traditionally been thought to enhance medical educational experience. These long and erratic work hours lead to acute and chronic sleep deprivation and poor sleep quality, resulting in numerous adverse consequences. Impairments may occur in several domains, including attention, cognition, motor skills, and mood. Resident performance, professionalism, safety, and well-being are affected by sleep deprivation, causing potentially adverse implications for patient care. Studies have shown adverse health consequences, motor vehicle accidents, increased alcohol and medication use, and serious medical errors to occur in association with both sleep deprivation and shift work. Resident work hour limitations have been mandated by the Accreditation Council for Graduate Medical Education in response to patient safety concerns. Studies evaluating the impact of these regulations on resident physicians have generated conflicting reports on patient outcomes, demonstrating only a modest increase in sleep duration for resident physicians, along with negative perceptions regarding their education. This literature review summarizes research on the effects of sleep deprivation and shift work, and examines current literature on the impact of recent work hour limitations on resident physicians and patient-related outcomes.
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Gonzalo J, Herzig S, Reynolds E, Yang J. Factors associated with non-compliance during 16-hour long call shifts. J Gen Intern Med 2012; 27:1424-31. [PMID: 22528621 PMCID: PMC3475826 DOI: 10.1007/s11606-012-2047-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 02/14/2012] [Accepted: 03/12/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Duty hour restrictions limit shift length to 16 hours during the 1(st) post-graduate year. Although many programs utilize a 16-hour "long call" admitting shift on inpatient services, compliance with the 16-hour shift length and factors responsible for extended shifts have not been well examined. OBJECTIVE To identify the incidence of and operational factors associated with extended long call shifts and residents' perceptions of the safety and educational value of the 16-hour long call shift in a large internal medicine residency program. DESIGN, PARTICIPANTS, AND MAIN MEASURES: Between August and December of 2010, residents were sent an electronic survey immediately following 16-hour long call shifts, assessing departure time and shift characteristics. We used logistic regression to identify independent predictors of extended shifts. In mid-December, all residents received a second survey to assess perceptions of the long call admitting model. KEY RESULTS Two-hundred and thirty surveys were completed (95 %). Overall, 92 of 230 (40 %) shifts included ≥ 1 team member exceeding the 16-hour limit. Factors independently associated with extended shifts per 3-member team were 3-4 patients (adjusted OR 5.2, 95 % CI 1.9-14.3) and>4 patients (OR 10.6, 95 % CI 3.3-34.6) admitted within 6 hours of scheduled departure and>6 total admissions (adjusted OR 2.9, 95 % CI 1.05-8.3). Seventy-nine of 96 (82 %) residents completed the perceptions survey. Residents believed, on average, teams could admit 4.5 patients after 5 pm and 7 patients during long call shifts to ensure compliance. Regarding the long call shift, 73 % agreed it allows for safe patient care, 60 % disagreed/were neutral about working too many hours, and 53 % rated the educational value in the top 33 % of a 9-point scale. CONCLUSIONS Compliance with the 16-hour long call shift is sensitive to total workload and workload timing factors. Knowledge of such factors should guide systems redesign aimed at achieving compliance while ensuring patient care and educational opportunities.
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Affiliation(s)
- Jed Gonzalo
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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