Abstract
BackgroundCurrent duty hour restrictions have led to increased patient handoffs as well as increased use of faculty in the nocturnist role. Nocturnists typically supervise residents and perform direct patient care leading to a diversity of provider experience level during morning handoffs. In this study, we explored how the presence of nocturnists impacts perceptions patient safety, quality, and educational value of morning care transitions.MethodsWe performed a cross-sectional survey examining the housestaff and attending perceptions of the morning sign-out of overnight admissions from both night float residents and nocturnists in July of 2016. Survey responses were Likert-style format, querying respondents’ level of agreement (1-5, strongly disagree to strongly agree) with statements. 108 providers responded (41% response rate)ResultsRelative to attendings, residents reported feeling like they had less time to ask questions (4.0 vs. 5.0, p < 0.001) and felt less comfortable asking questions of the nocturnist during handoff (4.0 vs. 5.0, p < 0.001). Residents were also less comfortable than attendings in changing a nocturnist’s plan of care (4.0 vs. 5.0, p < 0.001). Housestaff reported that receiving signout from the overnight resident was more likely to improve their confidence managing similar conditions (4.0 vs. 3.0, p < 0.001).ConclusionThe benefits of nocturnist supervision may come at an educational cost as trainees feel less comfortable asking questions or changing the plan of care. With increasingly prevalent night float systems and nocturnist providers, academic programs have to negotiate the balancing safe and high-quality patient care with creating positive learning environments and clear expectations.
Highlights
Verbal provider-to-provider handoffs are the most common mechanism for transitioning care in the inpatient setting [1]
Residents reported feeling like they had less time to ask questions (4.0 vs. 5.0, p < 0.001) and felt less comfortable asking questions of the nocturnist during handoff (4.0 vs. 5.0, p < 0.001)
Prior investigation has shown that residents found nocturnist presence enhanced the clinical value of the night float rotation, without compromising housestaff decision-making autonomy [16,17,18]
Summary
Verbal provider-to-provider handoffs are the most common mechanism for transitioning care in the inpatient setting [1]. The 2011 duty hour restrictions reduced inpatient resident shift length, leading to increased transitions of care between providers [2,3]. Increased housestaff supervision mandates and duty hour restrictions have led academic training institutions to employ overnight in-hospital faculty (nocturnists) [13,14,15]. No prior studies have examined the morning transition of care of newly hospitalized patients in this current academic environment, where patient care by overnight resident and faculty physicians is transferred to daytime clinicians. Nocturnists typically supervise residents and perform direct patient care leading to a diversity of provider experience level during morning handoffs. We explored how the presence of nocturnists impacts perceptions patient safety, quality, and educational value of morning care transitions
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