Drip System for Admissions to Resident Teams: Impact on Workload and Education. Issue 12 (December 2020)

• Record Type: Journal Article
• Authors: Berger, Stephanie; Nassetta, Lauren B.; Hofto, Meghan E.; Scalici, Paul; Pass, Robert F.
• Is Part Of: Southern medical journal. Volume 113:Issue 12(2020)
• Publication Date: 2020-12
• Subjects: academic hospitals -- bolus system -- call cycle -- drip system -- patient distribution; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000001183
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract: Objectives: Assigning patients to a call team every fourth day (bolus system) caused the maldistribution of patients among resident teams and required additional faculty effort for overflow patient care. We changed to a continuous daily rotation (drip system) and examined the effect on clinical workload among resident teams, resident education, and faculty utilization. Methods: This is a retrospective study based on the daily records of 7 AM team census, the attending physician schedules for a pediatric hospital medicine service with 5 teams, and the measures of resident education, including noon conference attendance, scores on in-service examinations, and duty hour violations. Data from the bolus system (May 2014–June 2015) were compared with the drip system (May 2016–June 2017). Results: Data from 348 bolus days and 338 drip days were analyzed. There was a decrease in interteam variation from 6.2 to 3.9 patients ( P < 0.001). There were fewer days with the following: large interteam variation (143 to 25, P < 0.001), days with resident teams at or above capacity (26 to 11, P = 0.01), resident teams below a minimum 7 AM census (133 to 18, P < 0.001), and days when additional faculty were pulled for clinical care (61 to 9, P < 0.001). Resident noon conference attendance was unchanged and there was no adverse effect on examination scores or duty hour violations. Conclusions: Changing from a bolus to a drip model for admissions to inpatient teams resulted in a more even distribution of the workload and a more efficient use of physician resources without negatively affecting resident education. Abstract : Traditional systems of admitting patients to a single on-call inpatient team can lead to the maldistribution of patients, unreasonable workloads on call days, negative impacts on resident education, and delays in patient care when there is a surge in new admissions. Changing from a call day (bolus) to a continuous rotation (drip) system led to greater equity in patient census and workloads across resident teams, decreased the need to call in backup hospitalists, and was associated with improved resident performance on in-training examinations.