An observational pre-post study of re-structuring Medicine inpatient teaching service

Improved continuity of care within constraint of 2011 duty hours

Joseph Y. Cheung, Daniel Mueller, Marissa Blum, Hannah Ravreby, Paul Williams, Darilyn Moyer, Malka Caroline, Chad Zack, Susan G. Fisher, Arthur M. Feldman

Research output: Contribution to journalArticle

Abstract

Background: Implementation of more stringent regulations on duty hours and supervision by the Accreditation Council for Graduate Medical Education in July 2011 makes it challenging to design inpatient Medicine teaching service that complies with the duty hour restrictions while optimizing continuity of patient care. Objective: To prospectively compare two inpatient Medicine teaching service structures with respect to residents' impression of continuity of patient care (primary outcome), time available for teaching, resident satisfaction and length-of-stay (secondary endpoints). Design: Observational pre-post study. Methods: Surveys were conducted both before and after Conventional Medicine teaching service was changed to a novel model (MegaTeam). Settings: Academic General Medicine inpatient teaching service. Results: Surveys before and after MegaTeam implementation were completed by 68.5% and 72.2% of internal medicine residents, respectively. Comparing conventional with MegaTeam, the % of residents who agreed or strongly agreed that the (i) ability to care for majority of patients from admission to discharge increased from 29.7% to 86.6% (p<0.01); (ii) the concern that number of handoffs was too many decreased from 91.9% to 18.2% (p<0.01); (iii) ability to provide appropriate supervision to interns increased from 38.1% to 70.7% (p<0.01); (iv) overall resident satisfaction with inpatient Medicine teaching service increased from 24.7% to 56.4% (p<0.01); and (v) length-of-stay on inpatient Medicine service decreased from 5.3±6.2 to 4.9±6.8 days (p<0.03). Conclusions: According to our residents, the MegaTeam structure promotes continuity of patient care, decreases number of handoffs, provides adequate supervision and teaching of interns and medical students, increases resident overall satisfaction and decreases length-of-stay.

Original languageEnglish (US)
Pages (from-to)129-134
Number of pages6
JournalHealthcare
Volume3
Issue number3
DOIs
StatePublished - Sep 1 2015

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Continuity of Patient Care
Inpatients
Teaching
Medicine
Length of Stay
Aptitude
Graduate Medical Education
Accreditation
Patient Admission
Internal Medicine
Medical Students

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

Cheung, Joseph Y. ; Mueller, Daniel ; Blum, Marissa ; Ravreby, Hannah ; Williams, Paul ; Moyer, Darilyn ; Caroline, Malka ; Zack, Chad ; Fisher, Susan G. ; Feldman, Arthur M. / An observational pre-post study of re-structuring Medicine inpatient teaching service : Improved continuity of care within constraint of 2011 duty hours. In: Healthcare. 2015 ; Vol. 3, No. 3. pp. 129-134.
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title = "An observational pre-post study of re-structuring Medicine inpatient teaching service: Improved continuity of care within constraint of 2011 duty hours",
abstract = "Background: Implementation of more stringent regulations on duty hours and supervision by the Accreditation Council for Graduate Medical Education in July 2011 makes it challenging to design inpatient Medicine teaching service that complies with the duty hour restrictions while optimizing continuity of patient care. Objective: To prospectively compare two inpatient Medicine teaching service structures with respect to residents' impression of continuity of patient care (primary outcome), time available for teaching, resident satisfaction and length-of-stay (secondary endpoints). Design: Observational pre-post study. Methods: Surveys were conducted both before and after Conventional Medicine teaching service was changed to a novel model (MegaTeam). Settings: Academic General Medicine inpatient teaching service. Results: Surveys before and after MegaTeam implementation were completed by 68.5{\%} and 72.2{\%} of internal medicine residents, respectively. Comparing conventional with MegaTeam, the {\%} of residents who agreed or strongly agreed that the (i) ability to care for majority of patients from admission to discharge increased from 29.7{\%} to 86.6{\%} (p<0.01); (ii) the concern that number of handoffs was too many decreased from 91.9{\%} to 18.2{\%} (p<0.01); (iii) ability to provide appropriate supervision to interns increased from 38.1{\%} to 70.7{\%} (p<0.01); (iv) overall resident satisfaction with inpatient Medicine teaching service increased from 24.7{\%} to 56.4{\%} (p<0.01); and (v) length-of-stay on inpatient Medicine service decreased from 5.3±6.2 to 4.9±6.8 days (p<0.03). Conclusions: According to our residents, the MegaTeam structure promotes continuity of patient care, decreases number of handoffs, provides adequate supervision and teaching of interns and medical students, increases resident overall satisfaction and decreases length-of-stay.",
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Cheung, JY, Mueller, D, Blum, M, Ravreby, H, Williams, P, Moyer, D, Caroline, M, Zack, C, Fisher, SG & Feldman, AM 2015, 'An observational pre-post study of re-structuring Medicine inpatient teaching service: Improved continuity of care within constraint of 2011 duty hours', Healthcare, vol. 3, no. 3, pp. 129-134. https://doi.org/10.1016/j.hjdsi.2015.05.001

An observational pre-post study of re-structuring Medicine inpatient teaching service : Improved continuity of care within constraint of 2011 duty hours. / Cheung, Joseph Y.; Mueller, Daniel; Blum, Marissa; Ravreby, Hannah; Williams, Paul; Moyer, Darilyn; Caroline, Malka; Zack, Chad; Fisher, Susan G.; Feldman, Arthur M.

In: Healthcare, Vol. 3, No. 3, 01.09.2015, p. 129-134.

Research output: Contribution to journalArticle

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T2 - Improved continuity of care within constraint of 2011 duty hours

AU - Cheung, Joseph Y.

AU - Mueller, Daniel

AU - Blum, Marissa

AU - Ravreby, Hannah

AU - Williams, Paul

AU - Moyer, Darilyn

AU - Caroline, Malka

AU - Zack, Chad

AU - Fisher, Susan G.

AU - Feldman, Arthur M.

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N2 - Background: Implementation of more stringent regulations on duty hours and supervision by the Accreditation Council for Graduate Medical Education in July 2011 makes it challenging to design inpatient Medicine teaching service that complies with the duty hour restrictions while optimizing continuity of patient care. Objective: To prospectively compare two inpatient Medicine teaching service structures with respect to residents' impression of continuity of patient care (primary outcome), time available for teaching, resident satisfaction and length-of-stay (secondary endpoints). Design: Observational pre-post study. Methods: Surveys were conducted both before and after Conventional Medicine teaching service was changed to a novel model (MegaTeam). Settings: Academic General Medicine inpatient teaching service. Results: Surveys before and after MegaTeam implementation were completed by 68.5% and 72.2% of internal medicine residents, respectively. Comparing conventional with MegaTeam, the % of residents who agreed or strongly agreed that the (i) ability to care for majority of patients from admission to discharge increased from 29.7% to 86.6% (p<0.01); (ii) the concern that number of handoffs was too many decreased from 91.9% to 18.2% (p<0.01); (iii) ability to provide appropriate supervision to interns increased from 38.1% to 70.7% (p<0.01); (iv) overall resident satisfaction with inpatient Medicine teaching service increased from 24.7% to 56.4% (p<0.01); and (v) length-of-stay on inpatient Medicine service decreased from 5.3±6.2 to 4.9±6.8 days (p<0.03). Conclusions: According to our residents, the MegaTeam structure promotes continuity of patient care, decreases number of handoffs, provides adequate supervision and teaching of interns and medical students, increases resident overall satisfaction and decreases length-of-stay.

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