Abstract
Limitations on resident duty hours have been widely introduced with the intention of decreasing resident fatigue and improving patient outcomes. While there is evidence of improvement in resident well-being and education following such initiatives, they have inadvertently resulted in increased number of hand-offs between clinicians leading to potential errors in patient care. Current literature emphasizes need for more specialty/setting-specific scheduling, while considering residents’ opinions when implementing duty-hour reforms. There are no reports examining the impact of duty-hour changes on residents or patients in psychiatric emergency service (PES) settings. Our purpose was to assess the impact of a recent scheduling change and decrease in overall duty hours, on resident well-being and sense of burnout, while also evaluating changes to patient wait-time and length of stay (LOS) in PES. Residents completed Maslach Burnout Inventory and anonymous surveys focusing on: fatigue, sleep, life outside work for shifts - regular (8 am-8 pm) and swing shifts (12 pm–10 pm). Data from the electronic medical records were collected for 6 months pre- and post-schedule change (January 2016–February 2017), for LOS and patient wait-time. Residents’ preference for shifts was split. However, 86% reported getting enough sleep during swing shifts, while 83% reported lack of sleep during regular shifts. The average patient wait-time and LOS significantly decreased from 169 to 147 and 690 to 515 min, respectively. The change to swing shifts significantly impacts LOS and patient wait-time. The short shifts demonstrated an improvement in well-being for residents, but were not the singular factor for overall resident satisfaction.
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Acknowledgements
We thank Alan Weinberg, Icahn School of Medicine at Mount Sinai, New York, for providing biostatistical services.
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The authors report no external funding source for this study.
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This work was completed in compliance with federal, state and institutional regulations, the Committee on Publication Ethics (COPE) guidelines, as well as confidentiality standards.
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The Maimonides Institutional Review Board/Research Committee determined that this activity does not meet the definition of human research (# 2016–11-08). The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Authors NB, PS, FL, MB and TJ declare that they have no conflicts of interest to disclose.
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Awards: This paper was judged as one of the best research papers at the 2017 RFM (resident, fellow, medical student) Scientific Paper Contest, New York State Psychiatric Association. Dr. Brainch was awarded third place in this competition.
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Brainch, N., Schule, P., Laurel, F. et al. Psychiatric Emergency Services - Can Duty-Hour Changes Help Residents and Patients?. Psychiatr Q 89, 771–778 (2018). https://doi.org/10.1007/s11126-018-9579-2
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DOI: https://doi.org/10.1007/s11126-018-9579-2