IMPACT OF A MEDICAL ICU IN-HOUSE NIGHT FELLOW ON RESIDENT EDUCATION, PROCEDURAL SUPERVISION, AND WELLNESS

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Across the United States, 24/7 in-house critical care coverage is a topic of great debate. The benefit of in-house intensivists remains unclear. Studies have evaluated the impact of in-house attending coverage on patient care, but there is limited data on the impact of medical intensive care unit (MICU) coverage by an in-house critical care fellow on resident education. Nonetheless, many programs are transitioning away from night fellow home call. The objective of this study was to evaluate if there was a perceived difference in resident education, procedural supervision and wellness after the implementation of an MICU in-house night fellow. METHODS: We conducted a retrospective, survey-based study of internal medicine residents’ perceptions of the impact of a transition to in-house fellow coverage of an MICU at night at a university-affiliated academic medical center. We developed a non-validated questionnaire for residents using a modified Likert structure. The survey was extended to all internal medicine residents and interns (n=110) regardless of prior experience in the MICU. Residents who reported having rotated through the MICU prior to the transition to an in-house night fellow (February 2017) were asked questions regarding perceptions of education, procedural supervision and wellness before that point when fellows previously took home call. All survey participants were asked questions regarding perceptions of an in-house night fellow’s effect on education, procedural supervision and wellness. All responses remained anonymous. RESULTS: The survey was extended to all internal medicine trainees. Eighty-five (77%) trainees completed the survey. Of those participants, 42 (49%) had rotated through the MICU prior to the initiation of an in-house night fellow. Regarding experiences prior to an in-house night fellow, 9 (21%) felt procedural supervision was good or excellent, 23 (55%) rated their stress level as high or very high, and 10 (24%) felt support with code blues was good or excellent. Since the implementation of an MICU in-house night fellow, 57 (67%) felt procedural supervision was good or excellent, 6 (7%) rated their stress as high or very high, and 67 (79%) rated support with code blues as good or excellent. Fifty-five (65%) felt their learning was rarely or never inhibited by an in-house night fellow. CONCLUSIONS: Prior studies have demonstrated no clear benefit to in-house attending staffing of ICUs and have raised concerns about its impact on trainee autonomy. Little has been published on the effects on an MICU in-house night fellow. Here we demonstrate that institution of in-house night fellow coverage improves residents’ perceptions of education, supervision and wellness. CLINICAL IMPLICATIONS: An MICU in-house night fellow may be an effective system for providing 24/7 in-house critical care coverage while preserving trainee autonomy and improving resident learning and supervision. DISCLOSURES: No relevant relationships by Laura Behlen, source=Web Response No relevant relationships by William Denney, source=Web Response no disclosure on file for Jessie Harvey