Changes in Inpatient Staffing Following Implementation of New Residency Work‐Hour Restrictions

1Riley Children's Hospital, Indianapolis, IN
2Riley Children's Hospital, Indianapolis, IN
3Riley Children's Hospital, Indianapolis, IN
4Riley Children's Hospital, Indianapolis, IN
5Elmhurst Hospital Center/Mt. Sinai School of Medicine, Elmhurst, NY

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 129

Background:

In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) mandated new residency work‐hour restrictions. These changes limited the maximum hours of continuous clinical responsibilities from 30 to 16 hours for interns, 24 hours for upper‐level residents. Our objective was to determine how inpatient staffing of non–critical care teaching services within pediatric residency programs has changed since this transition in work hours.

Methods:

In May 2012, an institutional review board–reviewed electronic survey was sent to all U.S. pediatric residency training programs via the Association of Pediatric Program Directors (APPD) Listserv. The survey was approved by the APPD research task force. We sent individual e‐mail reminders to nonresponding programs as well as an additional e‐mail to programs with resident night floats. We analyzed data to assess the use of resident night‐float systems and admission caps as well as the use of attending physicians in‐house at night.

Results:

Of 200 programs contacted, 152 programs responded (76% response rate), which represented 7828 total residents. Residency programs utilizing a night‐float system increased from 43% before to 71% after new work hours were implemented. Overall use of resident admission caps increased from 12% to 14.5%. Following implementation of new resident work‐hour restrictions, 23% of programs increased the number of attending physicians in‐house at night. Of these programs, 57% have increased the number of pediatric hospitalists in‐house at night, whereas 37% increased the number of pediatric ICU attendings. In addition, the number of programs with pediatric hospitalist attendings in‐house 24/7 has increased from 16% to 20%. Of the programs without 24/7 pediatric hospital attending coverage, 38% are planning on adding this coverage within the next 5 years. Only 12% of programs have no in‐house attending coverage at night of any kind.

Conclusions:

Significant variation exists in how pediatric residency programs have responded to the implementation of resident work‐hour restrictions. The most common changes include the addition of a resident night‐float system as well as an increase in the number of attending physicians present at night; primarily in the form of pediatric hospitalists and pediatric ICU attendings. A significant proportion of programs are planning to add 24/7 pediatric hospitalist coverage within the next 5 years.

To cite this abstract:

Oshimura J, Sperring J, Bauer B, Carroll A, Rauch D. Changes in Inpatient Staffing Following Implementation of New Residency Work‐Hour Restrictions. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 129. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/changes-in-inpatient-staffing-following-implementation-of-new-residency-workhour-restrictions/. Accessed July 23, 2019.

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