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Psychiatr Q. 2018 Dec;89(4):771-778. doi: 10.1007/s11126-018-9579-2.

Psychiatric Emergency Services - Can Duty-Hour Changes Help Residents and Patients?

Author information

1
Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, 11219, USA.
2
Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, 11219, USA. tjacob@maimonidesmed.org.

Abstract

Limitations on resident duty hours have been widely introduced with the intention of decreasing resident fatigue and improving patient outcomes. While there is evidence of improvement in resident well-being and education following such initiatives, they have inadvertently resulted in increased number of hand-offs between clinicians leading to potential errors in patient care. Current literature emphasizes need for more specialty/setting-specific scheduling, while considering residents' opinions when implementing duty-hour reforms. There are no reports examining the impact of duty-hour changes on residents or patients in psychiatric emergency service (PES) settings. Our purpose was to assess the impact of a recent scheduling change and decrease in overall duty hours, on resident well-being and sense of burnout, while also evaluating changes to patient wait-time and length of stay (LOS) in PES. Residents completed Maslach Burnout Inventory and anonymous surveys focusing on: fatigue, sleep, life outside work for shifts - regular (8 am-8 pm) and swing shifts (12 pm-10 pm). Data from the electronic medical records were collected for 6 months pre- and post-schedule change (January 2016-February 2017), for LOS and patient wait-time. Residents' preference for shifts was split. However, 86% reported getting enough sleep during swing shifts, while 83% reported lack of sleep during regular shifts. The average patient wait-time and LOS significantly decreased from 169 to 147 and 690 to 515 min, respectively. The change to swing shifts significantly impacts LOS and patient wait-time. The short shifts demonstrated an improvement in well-being for residents, but were not the singular factor for overall resident satisfaction.

KEYWORDS:

Duty hours; Psychiatric emergency services; Residents

PMID:
29654393
DOI:
10.1007/s11126-018-9579-2
[Indexed for MEDLINE]

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