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Raymond SL, Tagge E. A prospective observational study of sleep patterns and work-related communications during home call for a pediatric surgery fellow. Surg Open Sci 2024; 19:158-161. [PMID: 38745564 PMCID: PMC11091662 DOI: 10.1016/j.sopen.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/09/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024] Open
Abstract
Objective A pediatric surgery fellow is often regarded as a cornerstone of an academic children's hospital due to the need for their clinical services with overnight coverage being an important aspect of the care provided. There is little known about the objective sleep patterns and work-related communications of a pediatric surgery fellow during overnight home call. The aim of this study is to better understand the sleep patterns and interruptions of an on-call pediatric surgery fellow. Design A prospective observational study of 60 call nights and 60 non-call nights of a pediatric surgery senior fellow was performed from September 2022 to February 2023. Setting An academic Children's Hospital. Participant An ACGME-accredited clinical pediatric surgery fellow. Results On average, the pediatric surgery fellow spent 6.9 and 5.8 total hours in bed and asleep each night, respectively. The total sleep time was less for call nights compared to non-call nights (5.4 versus 6.3 h, p < 0.0001). The mean number of work-related communications per 12-hour night shift was four. The majority of communications were regarding new consults (63.8 %). The pediatric surgery fellow spent an average of 5.9 min per communication and approximately 23.8 min total during each 12-hour night shift. Approximately half of these communications occurred during sleep hours. Conclusions This study reveals overall sleep duration was below recommended levels. There were significant alterations in sleep patterns during call nights. Work-related communications further compounded sleep disturbances. Further research and interventions in this area are warranted.
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Affiliation(s)
- Steven L. Raymond
- Division of Pediatric Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Edward Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
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Klein R, Jackman S, Nelson J. A Single-resident Experience of Overnight Call Activity at a Multi-site Academic Health System. Urology 2024:S0090-4295(24)00336-4. [PMID: 38703953 DOI: 10.1016/j.urology.2024.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/29/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To characterize urology resident on-call activities overnight at a multi-site academic medical center and model the expected volume of clinical activity using inpatient beds, emergency room visits, and attendings covered. MATERIALS AND METHODS On-call activities for 70 13-hour overnight shifts spanning 5 nonconsecutive months between May 2022 and February 2023 were recorded. Clinical coverage included 5 academic hospitals encompassing 1761 staffed inpatient beds and an expected nightly volume of 255 Emergency Department (ED) visits. The time, source, and clinical features of every call were documented. RESULTS An average of 15 unique calls were received during each shift. Of these, 35% required an in-person evaluation and 12% required a bedside or operative procedure. Approximately a third of calls (36%) were received after midnight. An in-person evaluation occurred within the first hour of 53% of shifts and every shift required at least 1 evaluation. When normalized for inpatient bed volume, an average of 7 unique patient communications occurred per 1000 beds, leading to 2 in-person evaluations. When normalized for an expected number of overnight ED visits, an average of 1 new ED consultation occurred per 100 ED visits. CONCLUSION After-hours clinical coverage models vary significantly by specialty and institution, and coverage decisions must balance quality clinical care with safe provider workload. Patient needs were appropriately addressed by a single overnight on-call resident, providing a robust clinical experience. The volume of patient care activities in this experience supports the practice of a "night-float" resident with the clear expectation on-site care is required.
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Affiliation(s)
- Roger Klein
- UPMC Department of Urology, UPMC, Pittsburgh, PA.
| | | | - Joel Nelson
- UPMC Department of Urology, UPMC, Pittsburgh, PA
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Iwai Y, Ciociola EC, Carter TM, Pascarella L. Perceived Pager Burden Among Trainees Across Medical Specialties. Am Surg 2024:31348241241614. [PMID: 38520283 DOI: 10.1177/00031348241241614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
BACKGROUND The experiences of pager use among trainees across medical specialties is underexplored. The aim of this study was to assess experiences of pager burden and communication preferences among trainees in different specialties. METHODS An online survey was developed to assess perceived pager burden (eg, pager volume, mistake pages, sleep, and off-time interruptions) and communication preferences at a tertiary center in the United States. All residents and fellows were eligible to participate. Responses were grouped by specialty: General surgery [GS], Surgical subspecialty [SS], Medicine, Anesthesiology, and Psychiatry. Multivariable linear regression was used to assess factors associated with pager burden. Free text responses were analyzed using open coding methods. RESULTS Of the total 306 responses, the majority were female (58.8%), 30-39 years (59.2%), and White (70.6%). Specialty breakdown was: Medicine (40.2%), Psychiatry (10.8%), SS (18.0%), GS (5.6%), and Anesthesiology (3.6%). GS respondents reported receiving more mistake pages (P < .001), spending more time redirecting mistake pages (P = .003), and having the highest sleep time disruptions (P < .001). For urgent communications, surgical trainees preferred physical pagers, while nonsurgical trainees preferred smartphone pagers (P = .001). "Receive fewer nonurgent pages" was the most common change respondents desired. DISCUSSION In this single center study, subjective experiences of pager burden were disproportionately high among GS trainees. Reducing nonurgent and mistake pages are potential targets for improving trainee communication experiences. Hospitals should consider incorporating trainee preferences into paging systems. Additional studies are warranted to increase the sample size, assess generalizability of the findings, and contextualize trainee experiences with objective hospital-level paging data.
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Affiliation(s)
- Yoshiko Iwai
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Elizabeth C Ciociola
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Taylor M Carter
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Office of Surgical Education, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Luigi Pascarella
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
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Pattanaik S, Fastring D, Bateman RC. A Longitudinal Pilot Study of Stress and Sleep in First-Year Osteopathic Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231179532. [PMID: 37324050 PMCID: PMC10265315 DOI: 10.1177/23821205231179532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Poor sleep quality is thought to be a contributor to medical student stress. The authors evaluated the effect of high and low periods of academic stress on sleep quality and quantity in first-year medical students. METHODS A group of 25 students in their first year of medical school were provided Fitbit Charge 3 activity trackers for continual use and were surveyed at 4 intervals to assess stress level, sleep quantity, and sleep quality. Fitbit data were collected through the Fitbit mobile app and uploaded to the Fitabase (Small Steps Labs, LLC) server. Data collection times were scheduled around the academic exam schedule. Weeks in which testing occurred were identified as high-stress periods. Results from assessments were compared to nontesting periods of low stress. RESULTS During stressful periods, students slept an average of one hour less per 24-h period, took more naps, and reported poorer sleep quality than during the low-stress periods. No significant change was seen in the 4 surveyed intervals in sleep efficiency or sleep stages. CONCLUSION Students slept less and had poorer quality sleep in their main sleep event during stressful periods but attempted to compensate with increased napping and weekend catchup sleep. The objective Fitbit activity tracker data were consistent with and validated the self-reported survey data. Activity trackers could potentially be used to optimize the efficiency and quality of both student napping and main sleep events as one component of a stress reduction program for medical students.
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Affiliation(s)
| | - Danielle Fastring
- College of Osteopathic Medicine,
William Carey University, Hattiesburg, MS, USA
| | - Robert C. Bateman
- College of Osteopathic Medicine,
William Carey University, Hattiesburg, MS, USA
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Karhula K, Koskinen A, Ervasti J, Hakola T, Isoviita VM, Kivimäki I, Puttonen S, Oksanen T, Härmä M. Hospital physicians´ working hour characteristics and sleep quality: a cross-sectional analysis of realized working hour and survey data. BMC Health Serv Res 2022; 22:943. [PMID: 35869512 PMCID: PMC9308190 DOI: 10.1186/s12913-022-08336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hospital physicians’ work includes on-call duties to provide 24/7 health care. Previous studies using self-reported survey data have associated long working hours and on-call work with sleep difficulties. To reduce recall bias, we complemented survey data with payroll-based objective data to study whether hospital physicians’ realized working hours are associated with sleep.
Methods
The study was nested within the Finnish Public Sector study. We used survey data on 728 hospital physicians (mean age 43.4 years, 62% females) from 2015 linked to realized daily working hour data from 3 months preceding the survey. The associations of working hour characteristics with sleep quantity and quality were studied with multinomial logistic regression analysis adjusted for demographics, overall stressfulness of life situation, control over scheduling of shifts, and hospital district.
Results
One fourth (26%) of the participants reported short (≤6.5 h) average sleep duration. Frequent night work (> 6 shifts/91 days) was associated with short sleep (OR 1.87 95%CI 1.23–2.83) compared to no night work. Approximately one third (32%) of the physicians reported insufficient sleep. Physicians with long weekly working hours (> 48 hours) had higher odds for insufficient sleep (OR 1.78 95%CI 1.15–2.76) than physicians with short weekly working hours (< 40 hours). Insufficient sleep was also associated with frequent on-call duties (> 12 shifts/3 months OR 2.00 95%CI 1.08–3.72), frequent night work (OR 1.60 95%CI 1.09–2.37), and frequent short shift intervals (≤11 hours; > 12 times/3 months OR 1.65 95%CI 1.01–2.69) compared to not having these working hour characteristics. Nearly half of the physicians (48%) reported at least one sleep difficulty at least two times a week and frequent night work increased odds for difficulties in initiating sleep (OR 2.43 95%CI 1.04–5.69). Otherwise sleep difficulties were not associated with the studied working hour characteristics.
Conclusion
We used realized working hour data to strengthen the evidence on on-call work and sleep quality and our results advice to limit the frequency of night work, on-call shifts, short shift intervals and long weekly working hours to promote hospital physicians’ sufficient sleep.
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Zhang CJ, Walser E, Mierzwa A, Ott M. Learning Interrupted: Educational Impact of Interruptions on Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2022; 79:875-884. [PMID: 35185000 DOI: 10.1016/j.jsurg.2022.01.009] [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: 07/03/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The complex workflow of surgical residents in the workplace-based learning environment makes interruptions an unavoidable aspect of clinical work. Interruptions have been shown to affect cognitive load, surgical performance, and medical error. The purpose of this study was to describe the effects of interruptions on surgical resident education. DESIGN Junior residents were observed by 2 trained observers using time-motion methodology between September 2018-August 2019. Interruptions were identified and coded retroactively based on predefined criteria. We captured key features of interruptions including frequency, duration, task interrupted, outcome, and learner perceived educational value. SETTING This study took place at London Health Sciences Centre in London, Ontario, Canada, a tertiary level academic health care center associated with the Schulich School of Medicine & Dentistry at Western University. PARTICIPANTS Junior residents on a General Surgery service were eligible for participation. Participation was voluntary. 8 residents were observed over 24 clinical periods. RESULTS A total of 278.2 hours of resident workflow were observed, and 229 interruptions were recorded. Interruptions account for 57.9 minutes/day of a surgical resident (SD = 60.7). Interruptions occur at a frequency of 0.82 interruptions/hour. Disruptive interruptions, that interfere with the continuation or completion of the original task, occur at a frequency of 0.11 interruptions/hour. Disruptive interruptions occurred at a higher frequency of 0.34 interruptions/hour during periods of feedback, coaching and informal teaching. DISCUSSION We observed that tasks of higher learner perceived educational value are often interrupted by tasks of lower learner perceived education value. Valuable educational experiences such as feedback, coaching and informal teaching are interrupted at a greater rate and experience disruptions at a disproportionate rate. We identified feedback, coaching and informal teaching as an education task vulnerable to disruptive interruptions that would benefit from interventions targeted toward preventing interruption. Suggested interventions include "formalizing" feedback, coaching and informal teaching.
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Affiliation(s)
- Chris J Zhang
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Eric Walser
- Division of General Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Anna Mierzwa
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Michael Ott
- Schulich School of Medicine, Western University, London, Ontario, Canada; Division of General Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada; Center for Education Research and Innovation, Schulich School of Medicine, Western University, London, Ontario, Canada; Department of Oncology, Faculty of Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada.
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Fisher R, Chaggar R, Zenger A, Hamilton S, Carter W. Getting on the Same Page: A Quality Improvement Project to Enhance Nurse-to-Resident Communications and Reduce Overnight Sleep Interruptions. J Grad Med Educ 2022; 14:311-317. [PMID: 35754637 PMCID: PMC9200242 DOI: 10.4300/jgme-d-21-00846.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/06/2021] [Accepted: 02/28/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Many residency programs utilize "home call" residents who answer hospital communications and place orders from home. Often, residents are required to live nearby and arrive in-person if needed. Residents work normal daytime work hours while on home call, which can last several nights. This disrupts sleep and creates the potential for increased resident fatigue and patient safety issues. OBJECTIVE To implement and evaluate a novel program to reduce non-urgent overnight pages from nurses to home call physical medicine and rehabilitation (PM&R) residents between 11 pm and 6 am. METHODS At an inpatient acute rehabilitation unit in a tertiary care university teaching hospital, we implemented a 2-step prospective quality improvement study with interventions derived from nurse-physician meetings implemented 9 months apart in 2018 and 2019. The first intervention was a centralized nightly handoff sheet. The second intervention was to display suggested PRN medication lists in resident workrooms. The primary outcome measure was the percentage of nights with non-urgent pages between 11 pm and 6 am. Tracking urgent pages and 7-10 am emergent pages were used as balancing measures. RESULTS A total of 1835 text-based nursing pages (366 pre- and 1469 post-intervention) were received and categorized by content, urgency, and timing over a 17-month period. Post-intervention, there was a stable 25% decrease in nighttime non-urgent pages. The most common hour to be paged shifted from 11 pm to 8 pm. Pain, constipation, insomnia, and nausea were the most common complaints overnight. CONCLUSIONS By characterizing and studying nighttime pages, residents collaborated with nighttime nursing staff through structured meetings to reduce non-urgent nighttime pages for more than 1 year.
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Affiliation(s)
- Renae Fisher
- Renae Fisher, MD, is PM&R Spinal Cord Injury Medicine Fellow, Thomas Jefferson University
| | - Rajbir Chaggar
- Rajbir Chaggar, MD, is PM&R Chief Resident, Virginia Commonwealth University Health System
| | - Anthony Zenger
- Anthony Zenger, MD, is PM&R PGY-4 Resident, Commonwealth University Health System
| | - Susan Hamilton
- Susan Hamilton, RN, is Director of Nursing, Sheltering Arms Institute
| | - William Carter
- William Carter, MD, is PM&R Assistant Professor, Virginia Commonwealth University Health System
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