Dataset Information

Service census caps and unit-based admissions: resident workload, conference attendance, duty hour compliance, and patient safety.

ABSTRACT:

Objective

To examine the effect of census caps and unit-based admissions on resident workload, conference attendance, duty hour compliance, and patient safety.

Participants and methods

We implemented a census cap of 14 patients on 6 Mayo Clinic internal medicine resident hospital services and a unit-based admissions process in which patients and care teams were consolidated within hospital units. All 280 residents and 15,926 patient admissions to resident and nonresident services 1 year before the intervention (September 1, 2006, through August 31, 2007) and 1 year after the intervention (May 1, 2008, through April 30, 2009) were included. Residents' workload, conference attendance, and duty hours were tracked electronically. Patient safety variables including Rapid Response Team and cardiopulmonary resuscitation events, intensive care unit transfers, Patient Safety Indicators, and 30-day readmissions were compared preintervention and postintervention.

Results

After the intervention, residents' mean (SE) ratings of workload appropriateness improved (3.10 [0.08] vs 3.87 [0.08] on a 5-point scale; P<.001), as did conference attendance (1523 [56. 8%] vs 1700 [63.5%] conferences attended; P<.001). Duty hour violations for working more than 30 consecutive hours and not having 10 hours off between duty periods decreased from 77 of 9490 possible violations (0.81%) to 27 (0.28%) and from 70 (0.74%) to 14 (0.15%) violations, respectively (both, P<.001). Thirty-day readmissions to resident services decreased (1010 [18.14%] vs 682 [15. 37%]; P<.001). All other patient safety measures remained unchanged. After adjustment for illness severity, there were no significant differences in patient outcomes between resident and nonresident services.

Conclusion

Census caps and unit-based admissions were associated with improvements in resident workload, conference attendance, duty hour compliance, and readmission rates while patient outcomes were maintained.

SUBMITTER: Thanarajasingam U

PROVIDER: S-EPMC3538463 | biostudies-literature | 2012 Apr

REPOSITORIES: biostudies-literature

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Publications

Service census caps and unit-based admissions: resident workload, conference attendance, duty hour compliance, and patient safety.

Thanarajasingam Uma U McDonald Furman S FS Halvorsen Andrew J AJ Naessens James M JM Cabanela Rosa L RL Johnson Matthew G MG Daniels Paul R PR Williams Amy W AW Reed Darcy A DA

Mayo Clinic proceedings 20120401 4

<h4>Objective</h4>To examine the effect of census caps and unit-based admissions on resident workload, conference attendance, duty hour compliance, and patient safety.<h4>Participants and methods</h4>We implemented a census cap of 14 patients on 6 Mayo Clinic internal medicine resident hospital services and a unit-based admissions process in which patients and care teams were consolidated within hospital units. All 280 residents and 15,926 patient admissions to resident and nonresident services ...[more]

PMID: 22469344

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Dataset Information

Service census caps and unit-based admissions: resident workload, conference attendance, duty hour compliance, and patient safety.

Objective

Participants and methods

Results

Conclusion

Publications

Service census caps and unit-based admissions: resident workload, conference attendance, duty hour compliance, and patient safety.

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