Journal of General Internal Medicine

, Volume 27, Issue 11, pp 1424–1431

Factors Associated with Non-Compliance During 16-Hour Long Call Shifts

  • Jed Gonzalo
  • Shoshana Herzig
  • Eileen Reynolds
  • Julius Yang
Original Research



Duty hour restrictions limit shift length to 16 hours during the 1st 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.


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.


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.


medical education-graduate medical education systems-based practice duty hours 


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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Jed Gonzalo
    • 1
    • 2
  • Shoshana Herzig
    • 3
  • Eileen Reynolds
    • 4
  • Julius Yang
    • 5
  1. 1.Chief Medicine Resident and Clinical Teaching Fellow, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  2. 2.General Internal Medicine Medical Education FellowUniversity of Pittsburgh Medical Center/University of Pittsburgh School of MedicinePittsburghUSA
  3. 3.Division of General Medicine and Primary Care, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  4. 4.Internal Medicine Residency Program, Department of Medicine, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  5. 5.Silverman Institute for Healthcare Quality and Safety, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA

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