Objective:To determine whether the timing and number of patients admitted by internal medicine housestaff under a traditional call schedule affect the resource utilization and outcome of care for those patients.
Design:Retrospective cohort study, using existing computerized records.
Patients/participants:22,112 patients discharged from the internal medicine service who had been admitted by an on-call first-year resident between January 1, 1980, and December 31, 1987.
Measurements and main results:Admission after 5:00 PM was associated with decreased hospital length of stay (8.1%, p<0.0001), but increased total charges (3.1%, p=0.007). The relative risk of inpatient mortality for patients admitted at night was 1.21 (p=0.03). Patients of busier housestaff, as indicated by a larger number of on-call admissions, had lower total charges (1.7% decreased per admission) and no change in risk of inpatient mortality. While no linear relation was found between number of admissions and length of stay, analysis of nonlinear effects revealed that length of stay first rises, then falls as interns receive more on-call admissions.
Conclusions:The number and timing of admissions by oncall internal medicine housestaff are significantly related to length of hospital stay, total charges, and likelihood of inpatient mortality at one teaching hospital. These variations should be considered in planning the reform of residency training programs.
work schedule tolerance internship and residency time factors fatigue health planning guidelines quality of health care education night admissions
Hurwitz TA, Beiser M, Nichol H, Patrick L, Kozak J. Impaired interns and residents. Can J Psychiatry. 1987;32:165–9.PubMedGoogle Scholar
Friedman RC, Kornfeld DS, Bigger TJ Jr. Psychological problems associated with sleep deprivation in interns. J Med Educ. 1973;48:436–41.PubMedGoogle Scholar
Lurie N, Rank B, Parenti C, Woolley T, Snoke W. How do house officers spend their nights? A time study of internal medicine house staff on call. N Engl J Med. 1989;320:1673–7.PubMedCrossRefGoogle Scholar
Schwartz AJ, Black ER, Goldstein MG, Jozefowicz RF, Emmings FG. Levels and causes of stress among residents. J Med Educ. 1987;62:744–53.PubMedGoogle Scholar