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315 LESSONS LEARNED FROM A WEB-BASED DUTY HOURS TRACKING SYSTEM
  1. C. P. Nelson,
  2. C. B. Turley,
  3. J. L. Gonzalez
  1. Galveston, TX.

Abstract

Background and Purpose Residency programs have been directed to comply with specific guidelines for resident duty hours. The office of pediatric resident education at the University of Texas Medical Branch developed a Web-based monitoring tool to capture hourly data regarding resident activities and the following violations: residents who log more than 30 hours on continuous duty, more than 80 hours in one week, less than 10 hours off between duty shifts and those who will exceed their duty hours before the end of an 80 hour work week.

Methods Every categorical pediatrics and internal medicine-pediatrics resident assigned to pediatric rotations from July 1 to October 12, 2004 entered their daily activities prospectively. Each hour was assigned to one of six categories determined to constitute “duty hours” activities: Administrative duties related to patient care, transfer of patient care, time in-house during call, teaching activities, patient care and scheduled academic activities or as a “break.” Duty hours' violations were calculated automatically for each rotation and resident.

Results Seventy-three out of 148 resident months had at least one violation. Overall there were 230 individual violations during this 4 month period. Of these, 160/230 (70%) occurred during inpatient rotations, 10/230 (4%) occurred during outpatient rotations and 60/230 (26%) occurred during intensive care rotations. In this same time period, the distribution of experiences was 39% inpatient, 45% outpatient and 16% intensive care. Every intern and senior resident (3rd or 4th year) had at least one violation. Five out of 16 second year residents had no violations. Review of inpatient data revealed that residents report spending 73% of their hours performing patient care, 7.7% completing administrative duties and 0.4% teaching. Further analysis of specific activities and relationship to duty hours' violations is under way.

Conclusions Our Web-based system permits residents to enter duty hour data in a timely fashion and provides notification to program administrators to allow for proactive and continuous monitoring. Despite changes made to our schedule prior to implementing this monitoring system, every rotation with overnight call had more than one duty hours' violation and resident inpatient rotations had more violations than outpatient. Opportunities to reduce the number of violations during inpatient services likely reside with reduction of individual patient care responsibilities. Improved understanding of specific activities on each rotation and establishing linkages to violations will allow for modifications and improve overall rotation quality.

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