Shifting Duties to After Hours in the Era of Work‐Hour Restrictions

1UCSF, San Francisco, CA
2UCSF, San Francisco, CA
3UCSF, San Francisco, CA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 99


A better understanding of how resident physicians allocate their time is critical to making informed changes in resident schedules, given duty‐hour restrictions. Little is known about how much work residents defer to their off hours. We tracked the timing, frequency, and duration of time spent in dictating discharge summaries in order to determine how often this nondirect patient care–oriented task was performed after hours.


We tracked the length and timing of all discharge dictations performed by internal medicine residents at a single academic medical center from January to June 2009. Residents dictate summaries into a telephone data management system, which we then queried to determine the timing and length of each dictation and whether they were done during regular versus after hours. After‐hours dictations were defined as those completed on the postcall day after reaching their mandated duty‐hours limit, after 6 pm, on scheduled days off, and during the month subsequent to their rotation. We also surveyed residents regarding their perceptions of the length and number of dictations performed during their rotation.


We obtained data on 1152 dictations, Thirty‐nine residents spent a mean 6.5 hours dictating 30 dictations per month, with a mean on‐phone time of 13 minutes (range 4.6–30 minutes) per dictation. Twenty‐nine percent of dictation time was conducted after hours (Table 1). Residents significantly overestimated the median number (40 vs. 30 dictations, P < 0.001) and average length (18 vs. 13 minutes, P < 0.001) of their dictations.


Within current duty‐hour regulations, residents shift a substantial amount of time performing non– patient care work to after hours. However they also significantly overestimate the number and time spent on dictations. More accurate and abjective ways to assess resident work flow are needed to inform changes to resident schedules.

Author Disclosure:

M. Mourad, none; J. Kohlwes, none; A. Vidyarthi, none.

To cite this abstract:

Mourad M, Kohwles J, Vidyarthi A. Shifting Duties to After Hours in the Era of Work‐Hour Restrictions. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 99. Journal of Hospital Medicine. 2010; 5 (suppl 1). Accessed May 23, 2019.

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