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Psychiatric Emergency Services - Can Duty-Hour Changes Help Residents and Patients?

  • Navjot Brainch
  • Patrick Schule
  • Faith Laurel
  • Maria Bodic
  • Theresa Jacob
Original Paper
  • 53 Downloads

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.

Keywords

Duty hours Residents Psychiatric emergency services 

Notes

Acknowledgements

We thank Alan Weinberg, Icahn School of Medicine at Mount Sinai, New York, for providing biostatistical services.

Funding

The authors report no external funding source for this study.

Compliance with Ethical Standards

This work was completed in compliance with federal, state and institutional regulations, the Committee on Publication Ethics (COPE) guidelines, as well as confidentiality standards.

Ethical Approval

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.

Conflict of Interest

Authors NB, PS, FL, MB and TJ declare that they have no conflicts of interest to disclose.

References

  1. 1.
    Elmariah H, Thomas S, Boggan JC, Zaas A, Bae J. The burden of burnout. Am J Med Qual. 2017;32(2):156–62.CrossRefPubMedGoogle Scholar
  2. 2.
    Moeller A, Webber J, Epstein I. Resident duty hour modification affects perceptions in medical education, general wellness, and ability to provide patient care. BMC Med Educ. 2016;16(1):175.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Jain G, Dzara K, Mazhar MN, Punwani M. Do regulated resident working hours affect medical graduate education? Trends in the American psychiatry board pass rates pre- and post- 2003 duty hours regulations. Psychiatr Bull. 2014;38(6):299–302.CrossRefGoogle Scholar
  4. 4.
    Bolster L, Rourke L. The effect of restricting Residents' duty hours on patient safety, resident well-being, and resident education: an updated systematic review. J Grad Med Educ. 2015;7(3):349–63.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Mathew R, Gundy S, Ulic D, Haider S, Wasi P. A reduced duty hours model for senior internal medicine residents: a qualitative analysis of Residents' experiences and perceptions. Acad Med. 2016;91(9):1284–92.CrossRefPubMedGoogle Scholar
  6. 6.
    Anderson-Shaw L, Zar FA. Evidence-based practice and policy: ACGME resident duty hours-more harm than help. Am J Bioeth. 2016;16(9):20–2.CrossRefPubMedGoogle Scholar
  7. 7.
    Greenberg WE, Borus JF. The impact of resident duty hour and supervision changes: a review. Harv Rev Psychiatry. 2016;24(1):69–76.CrossRefPubMedGoogle Scholar
  8. 8.
    McIlwrick J, Lockyer J. Resident training in the psychiatric emergency service: duty hours tell only part of the story. J Grad Med Educ. 2011;3(1):26–30.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory manual. Palo alto, Calif. (577 college Ave., Palo alto 94306). Consulting psychologist press. 1996.Google Scholar
  10. 10.
    Weiss AP, Chang G, Rauch SL, Smallwood JA, Schechter M, Kosowsky J, et al. Patient and practice-related determinants of emergency department length of stay for patients with psychiatric illness. Ann Emerg Med. 2012;60(2):162–71.CrossRefPubMedGoogle Scholar
  11. 11.
    Hazlett S, McCarthy ML, Londner MS, et al. Epidemiology of adult psychiatric visits to. U. S. emergency departments. Acad Emerg MedAcad Emerg Med. 2004;11(2):193–5.CrossRefGoogle Scholar
  12. 12.
    Bara LJ, Janowicz N, Asarnow JR. Survey of California emergency departments about practices for management of suicidal patients and resources available for their care. Ann Emerg Med. 2006;48(4):452–9.CrossRefGoogle Scholar
  13. 13.
    Hickey L, Hawton K, Fagg J, Weitzel H. Deliberate self- harm patients who leave the accident and emergency department without a psychiatric assessment: a neglected population at risk of suicide. J Psychosom Res. 2001;50(2):87–93.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry, Maimonides Medical CenterBrooklynUSA

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