Service Census Caps and Unit-Based Admissions: Resident Workload, Conference Attendance, Duty Hour Compliance, and Patient Safety

Abstract Objective To examine the effect of census caps and unit-based admissions on resident workload, conference attendance, duty hour compliance, and patient safety. Participants and Methods We implemented a census cap of 14 patients on 6 Mayo Clinic internal medicine resident hospital services a...

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Bibliographic Details
Published in:Mayo Clinic proceedings 2012-04, Vol.87 (4), p.320-327
Main Authors: Thanarajasingam, Uma, MD, PhD, McDonald, Furman S., MD, MPH, Halvorsen, Andrew J., MS, Naessens, James M., ScD, Cabanela, Rosa L., PhD, Johnson, Matthew G., MPH, Daniels, Paul R., MD, Williams, Amy W., MD, Reed, Darcy A., MD, MPH
Format: Article
Language:English
Subjects:
Analysis
Biological and medical sciences
Care and treatment
Congresses as Topic
General aspects
Health participants
Hospital Units - organization & administration
Humans
Influence
Internal Medicine
Internship and Residency
Medical sciences
Miscellaneous
Occupational medicine
Original
Outcome Assessment, Health Care
Patient Admission
Patient Safety
Patients
Personnel Staffing and Scheduling
Prospective Studies
Public health. Hygiene
Public health. Hygiene-occupational medicine
Residents (Medicine)
Services
Work hours
Work Schedule Tolerance
Workload
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Summary:Abstract Objective To examine the effect of census caps and unit-based admissions on resident workload, conference attendance, duty hour compliance, and patient safety. Participants and Methods We implemented a census cap of 14 patients on 6 Mayo Clinic internal medicine resident hospital services and a unit-based admissions process in which patients and care teams were consolidated within hospital units. All 280 residents and 15,926 patient admissions to resident and nonresident services 1 year before the intervention (September 1, 2006, through August 31, 2007) and 1 year after the intervention (May 1, 2008, through April 30, 2009) were included. Residents' workload, conference attendance, and duty hours were tracked electronically. Patient safety variables including Rapid Response Team and cardiopulmonary resuscitation events, intensive care unit transfers, Patient Safety Indicators, and 30-day readmissions were compared preintervention and postintervention. Results After the intervention, residents' mean (SE) ratings of workload appropriateness improved (3.10 [0.08] vs 3.87 [0.08] on a 5-point scale; P
ISSN:0025-6196
1942-5546
DOI:10.1016/j.mayocp.2011.12.012