Effect of Work Hours, Caseload, Shift Type, and Experience on Resident Call Performance

Abstract

To analyze the independent effects of multiple variables on resident call performance. Independent radiology resident "on call" cross-sectional imaging interpretation quality assurance (QA) data obtained during a 171-day period at a single tertiary care Level 1 trauma teaching institution was reviewed. Clinically significant resident-faculty discrepancies were compared among three different call types: traditional single-day overnight call (OC, 15 hours/night after 9 daytime hours on weekdays), 7-night nightfloat (NF, 9 hours/night), and weekend day call (WD, 10 hours/day). Logistic regression analyses were performed to evaluate associations. There were 119 (0.89%) clinically significant resident-faculty discordances from 13,424 cross-sectional interpretations: 56 (0.79%) from 7102 interpretations on 172 OC shifts, 39 (0.85%) from 4567 interpretations on 165 NF shifts, and 24 (1.4%) from 1755 interpretations on 49 WD shifts. Individual residents (n = 20) had a mean discrepancy rate of 0.9% (0.45%-1.9%). Overall, 102 (26.2%) of the shifts had at least one discordance. The following were associated with significantly (P < .001) increased discrepancy rates: junior vs. senior residents (odds ratio [OR] = 1.3 [1.2-1.4]), OC vs. NF (OR = 1.5 [1.3-1.6], WD vs. NF (OR = 1.4 [1.2-1.6]), weekend vs. weekday (OR = 1.3 [1.2-1.4]), and increasing cases/hour (OR = 1.6 [1.5-1.7]). Weekend OC shifts had a higher discrepancy rate (OR 1.3[1.2-1.5], P < .001) than weekday OC shifts despite a shorter workday (15 vs. 24 hours). Increasing caseload, junior residents, and weekends are associated with a significantly higher discrepancy rate. OC is associated with a significantly higher discrepancy rate than NF. Measured discrepancy rates are low, regardless of call type.