Resident Duty Hours in the Outpatient Electronic Health Record Era: Inaccuracies and Implications

Abstract

The Accreditation Council for Graduate Medical Education expects resident duty hours to be monitored, yet no previous studies have examined the effect of after-hours electronic health record (EHR) use on resident hours or burnout. We assessed internal medicine residents' perceived and actual time spent on after-hours outpatient EHR use and calculated increased duty hours if after-hours EHR use were included; we also assessed its effect on resident burnout. We retrospectively aggregated time spent logged on to the outpatient EHR for residents in a general internal medicine clinic for 13weeks in 2011. Residents completed a survey on EHR use, which was correlated with objectively recorded data on EHR usage. We compared actual and self-reported EHR time and identified violations that would be generated if these hours were included in reported duty hours. We also correlated resident after-hours EHR use with responses to an internally developed burnout survey. The 44 residents in this study overestimated time spent on the ambulatory EHR (they spent 3.03hours/week on after-hours use compared with a recorded 1.20hours/week). In total, 190 duty hour violations (mean duration of violation  =  37minutes) would have been generated if after-hours EHR usage were included in residents' reported duty hours. Resident estimates of EHR use by residents were not accurate; including after-hours EHR use would increase the number of reported duty hour violations. There was no association between after-hours EHR use and resident burnout.