Feasibility of and barriers to continuity of care in US general surgery residencies with an 80-hour duty week

Abstract Background The current level of continuity of care for following up a single patient through preoperative evaluation, surgery, and postoperative care is unknown. Methods A survey of residents was performed, asking for their best guess regarding the number of patients seen for 6 common and 4...

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Bibliographic Details
Published in:The American journal of surgery 2011-03, Vol.201 (3), p.310-314
Main Authors: Morrissey, Shawna, D.O, Dumire, Russell, M.D, Bost, James, Ph.D, Gregory, James S., M.D
Format: Article
Language:English
Subjects:
80-Hour work week
Adult
Biological and medical sciences
Continuity
Continuity of care
Continuity of Patient Care
Duty-hour restrictions
Ethics
Feasibility Studies
Female
General aspects
General Surgery - education
General surgery residency training
Health participants
Humans
Internship and Residency - standards
Internship and Residency - statistics & numerical data
Internship and Residency - trends
Male
Medical residencies
Medical sciences
Night
Ostomy
Patients
Personnel Staffing and Scheduling - standards
Personnel Staffing and Scheduling - trends
Physicians
Polls & surveys
Public health. Hygiene
Public health. Hygiene-occupational medicine
Restrictions
Surgeons
Surgery
United States
Workload - statistics & numerical data
Workweeks
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Summary:Abstract Background The current level of continuity of care for following up a single patient through preoperative evaluation, surgery, and postoperative care is unknown. Methods A survey of residents was performed, asking for their best guess regarding the number of patients seen for 6 common and 4 uncommon surgeries, and ranking barriers to continuity of care. The length of time to achieve single-patient continuity of care in 5 patients was derived as well as the creation of odds ratios for the barriers. Results A total of 274 residents (56 programs) completed surveys. Residency length was 7 years for common surgeries and 9 for complex surgeries. The 30-hour work restrictions, inability to attend clinic, and floor/ward duties were the barriers to continuity of care. These data were unaffected by type of program, the presence of a night float system, or residency year. Conclusions Achieving the level of continuity of care used in this article will require a radical change in the length or structure of general surgery residency programs.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2010.09.019