The purpose of this study is to determine the impact of eliminating traditional resident work shifts (i.e. greater than 24 hours in length) on patient safety and resident educational outcomes. In addition, the investigators will explore with key stakeholders (patients and their families, nurses, resident physicians and attending physicians) their experiences when residents are undertaking shifts greater than 24 hours in length as compared to 16 hours or less.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
80
Shiftwork schedule with elimination of shifts greater than 16 hours in length and at least 8 hours off between shifts for all residents in the Intensive Care Unit
St Paul's Hospital
Vancouver, British Columbia, Canada
RECRUITINGPreventable adverse events
The primary outcome is the rate of preventable adverse events per 1000 patient days. An adverse event will be defined as any unplanned injury arising as a consequence of medical care that is associated with morbidity, requires treatment, prolongs hospital stay, or results in disability at discharge. Adverse events are not caused by the disease process itself, but do include any procedural or therapeutic complications. Preventable adverse events will be defined as those adverse events that could have been avoided given current knowledge and standards of care.
Time frame: Occurring during course of ICU admission and within first 72 hours of ICU discharge if event is attributable to process of care in the ICU
Quantity of scheduled and unscheduled learning activities residents participate in
Assessed by review of sleep/activity log
Time frame: End of each 28 day rotation
Resident leisure time, sleep, and time spent in the hospital
Assessed by review of sleep/activity log
Time frame: End of each 28 day rotation
Professionalism
In order to further explore this qualitative outcome measure, during structured interviews of residents, attending physicians, nurses and patients and their families, specific questions will be used to probe the perceived level of resident professionalism. For example, degree of commitment and professional investment in individual patients, and degree of commitment to the profession of medicine.
Time frame: End of each 28 day rotation
Nursing impact
In order to further explore this qualitative outcome measure, during focus groups with nurses specific questions will be used to probe the perceived level of impact on nursing.
Time frame: Over course of study (12 months)
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Attending physician workload
In order to further explore this qualitative outcome measure, during structured interviews of attending physicians specific questions will be used to probe the perceived level of physician workload. For example, the difference in level of direct involvement in patient care activities (writing notes, performing procedures, etc) between the two schedules.
Time frame: Over course of study (12 months)
Perceived continuity of care
In order to further explore this qualitative outcome measure, during structured interviews of residents, attending physicians, nurses and patients and their families, specific questions will be used to probe the perceived level of continuity of care.
Time frame: Over course of study (12 months)
Quality of life
In order to further explore this qualitative outcome measure, during structured interviews of residents specific questions will be used to probe the perceived level of quality of life for the different call schedules.
Time frame: End of each 28 day rotation
Resident knowledge acquisition and retention
Scores on validated multiple choice question exams
Time frame: End of each 28 day rotation
Patient satisfaction
Given the multitude of potential variables that impact patient satisfaction, during the interviews of patients and their families, the following questions will be used to inform the outcome measure: a global assessment of the patient's experience, their satisfaction with the overall care provided by the healthcare team and their satisfaction with their experiences with resident physicians in particular.
Time frame: Within two weeks of ICU discharge
Job satisfaction/Stress
In order to further explore this qualitative outcome measure, during structured interviews of residents specific questions will be used to probe the perceived level of job satisfaction and stress for the different call schedules.
Time frame: End of each 28 day rotation