Hospitalist Heralds Shift-Based Work

While most academic hospitalist groups might be struggling with the practicalities of new resident work-hour rules, pediatric hospitalist Glenn Rosenbluth, MD, sees an opportunity if the rules spur a migration from traditional call models to shift-based work.

Dr. Rosenbluth and colleagues at University of California at San Francisco’s (UCSF) Benioff Children’s Hospital are working on research that shows a shift-based model that complies with Accreditation Council for Graduate Medical Education (ACGME) guidelines can cut costs and reduce length of stay (LOS). The ACGME work-hour rules limit first-year residents to 16-hour shifts.

At UCSF Benioff, the traditional call model (with 30-hour shifts) was replaced by shift work in 2008. Medical inpatient teams now feature four interns working four-week blocks. Three weeks are scheduled as day shifts, with one week of night shifts.

"It’s not that I think scheduling is the magic bullet," Dr. Rosenbluth says. "But I think scheduling can be leveraged."

In an abstract published in the Journal of Hospital Medicine, Dr. Rosenbluth and colleagues compared LOS and total cost for admitted patients diagnosed with the hospital’s 10 most common pediatric diagnoses during the year before and after the schedule change. When the review was limited to non-ICU patients, LOS was reduced by 18% (rate ratio, 0.82; 95% CI, 0.73-0.93), and total costs were cut 10% (0.90; 95% CI,0.81-0.99). Dr. Rosenbluth says the model also has increased the staff’s ownership of night patients, as interns moving from night shift to day shift will often see the same children.

Dr. Rosenbluth hopes to further his research to draw even more evidence-based conclusions. "I think shorter shifts are the way to go and I think our model shows that," he says. "I haven’t proven that, but I do believe that. And that’s what we’re looking to study."

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