Abstract
Monitoring and managing resident workload is a cornerstone of policy in graduate medical education, and the duty hours metric is the backbone of current regulations. While the duty hours metric measures hours worked, it does not capture differences in intensity of work completed during those hours, which may independently contribute to fatigue and burnout. Few such metrics exist. Digital data streams generated during the usual course of hospital operations can serve as a novel source of insight into workload intensity by providing high-resolution, minute-by-minute data at the individual level; however, study and use of these data streams for workload monitoring has been limited to date. Paging data is one such data stream. In this work, we analyze over 500,000 pages—two full years of pages in an academic internal medicine residency program—to characterize paging patterns among housestaff. We demonstrate technical feasibility, validity, and utility of paging burden as a metric to provide insight into resident workload beyond duty hours alone, and illustrate a general framework for evaluation and incorporation of novel digital data streams into resident workload monitoring.
Highlights
Resident workload has been in the public conscience since at least 1984, when the death of college student Libby Zion was proposed to be linked to resident fatigue.[1]
We explore whether paging burden is a metric that demonstrates variation even when duty hours are similar
Analysis of large-scale paging data—which we term PAGEOMICS (Paging Analytics Guided Exploration of Medicine in Clinical Settings)—can serve as a novel source of high-resolution information informative of resident workload and hospital operations
Summary
Resident workload has been in the public conscience since at least 1984, when the death of college student Libby Zion was proposed to be linked to resident fatigue.[1] In subsequent years, additional studies have suggested that long work hours are associated with adverse events affecting both house officers and potentially their patients.[2,3] To limit resident overwork, resident workload restrictions were recommended and mandated. Most studies to date involve manual analysis of smaller-scale paging datasets[7,8,9,10]; no studies have characterized paging patterns in an academic medical residency program across multiple years, and even basic questions such as “How many pages does an internal medicine resident receive per year” remain unanswered
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