Development and Implementation of a Novel On-Call Structure for Paediatric Residents. (1st June 2016)

• Record Type: Journal Article
• Authors: Cawthorn, T; Ruhl, M; Dhalla, M; Lam, S; Hall, S
• Is Part Of: Paediatrics & Child Health. Volume 21(2016)Supplement 5
• Page Start: e77
• Page End: e77
• Publication Date: 2016-06-01
• Subjects: Pediatrics -- Periodicals; Children -- Health and hygiene -- Periodicals; 618.92
• DOI: 10.1093/pch/21.supp5.e77
• Languages: English
• ISSNs: 1205-7088

Abstract

Abstract: BACKGROUND: At the Alberta Children's Hospital, residents provide 24-hour coverage of inpatient units through several shifts: a day team, an evening team, an overnight team, and a weekend team. The evening shift was designed to limit consecutive hours worked by the night team, allowing provision of five consecutive nights of coverage. Recently, residents and Hospitalist Pediatricians expressed a desire to optimize the continuity of care provided by our call system. Cross-covering residents working the evening shift felt that they were at higher risk of committing an error during these times. Furthermore, there were external pressures to reduce consecutive resident work hours to less than 15 hours. OBJECTIVES: To design and implement a novel call system for pediatric residents at the Alberta Children's Hospital. DESIGN/METHODS: A committee was established to identify areas for improvement. Based on stakeholder input, a novel system was created that centered on a 12 hour construct (0800-2000) with a primary "day team" and "night team" for each weekday. A key feature of the system ensured that weekday coverage was provided by "on-service" residents (residents on a CTU rotation) and that weekend coverage was provided by "off-service" residents (on other rotations). The first iteration of the new call system was implemented in April of 2015. RESULTS: A total of 19 residents completed a 6 month follow-up survey in November of 2015;89% of polled residents felt the new system was superior to the previous system. The majority of residents (84%) felt that patient care was improved during the weekdays, with the remaining residents indicating that weekday care was unchanged. Weekend care was felt to be unchanged under the new system by the majority of residents (74%). There were differing opinions on the impact of the new system on resident fatigue level (38% improved, 22% unchanged, 12% worsened, 27% unsure). Surveys indicated that the new system was associated with a lower perceived risk of committing a medical error across all shifts. CONCLUSION: We were able to successfully implement a novel call system which dose not rely on either an evening "covering" shift, or 24 hour shifts. The new call system was very well received by all stakeholders and was associated with improved resident perception of patient care during the week, and decreased perceived risk of medical error across all shifts. The new system was also associated with a trend toward reduced resident fatigue overall.