Pediatric trainees systematically under-report duty hour violations compared to electronic health record defined shifts.

Adam C. Dziorny,Nicole Washington,Nicole A. Hames,Evan W. Orenstein,Bimal Desai,Robert B. Lindell,Rodrigo Romao

doi:10.1371/journal.pone.0226493

Abstract

Duty hour monitoring is required in accredited training programs, however trainee self-reporting is onerous and vulnerable to bias. The objectives of this study were to use an automated, validated algorithm to measure duty hour violations of pediatric trainees over a full academic year and compare to self-reported violations. Duty hour violations calculated from electronic health record (EHR) logs varied significantly by trainee role and rotation. Block-by-block differences show 36.8% (222/603) of resident-blocks with more EHR-defined violations (EDV) compared to self-reported violations (SRV), demonstrating systematic under-reporting of duty hour violations. Automated duty hour tracking could provide real-time, objective assessment of the trainee work environment, allowing program directors and accrediting organizations to design and test interventions focused on improving educational quality.

Highlights

To reduce errors associated with fatigue, the Accreditation Council for Graduate Medical Education mandates duty hour restrictions on trainees [1] but does not stipulate how monitoring should be accomplished [2]
A total of 168 resident-blocks (22%) from 23 trainees (17%) contained zero self-reported shifts (SRS) and were excluded when the analyses included Self-reported shifts (SRS). This exclusion resulted in 603 resident-blocks (78%) from 116 trainees (83%) eligible for paired EHR-defined violations (EDV)-self-reported violations (SRV) analysis
Mean total electronic health record (EHR)-defined violations (EDV) per block for all resident-blocks varied by role (Mean±SEM: Jr FLC 0.6±0.06, Sr FLC 2.4±0.11, Sr Suprv 1.4±0.12; p

Summary

Introduction

To reduce errors associated with fatigue, the Accreditation Council for Graduate Medical Education mandates duty hour restrictions on trainees [1] but does not stipulate how monitoring should be accomplished [2]. Self-report systems are common [3] but are onerous for trainees to complete and vulnerable to recall bias and both under- and over-reporting [4,5]. Numerous single- and multi-institution surveys have demonstrated that trainees across many specialties substantially under-report duty hours [6,7,8,9].

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Methods

Results

Conclusion