C. Thiessen1, L. S. Lehmann3, F. G. Javier5, M. J. Erlendson5, L. A. Skrip4, M. R. Mercurio2, K. A. Davis1 1Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA 2Yale University School Of Medicine,Department Of Pediatrics,New Haven, CT, USA 3Brigham And Women’s Hospital,Department Of Medicine,Boston, MA, USA 4Yale School Of Public Health,Department Of Epidemiology Of Microbial Diseases,New Haven, CT, USA 5Yale University School Of Medicine,New Haven, CT, USA
Introduction: With the spread of electronic medical records, residents have increasing opportunities to do patient care work at home. ACGME guidance specifies that patient work at home should count toward the resident hour limits. This study evaluated the amount and type of patient care work residents report performing at home, and why they do so.
Methods: Residents at 26 general surgery and internal medicine residency programs were invited to take an anonymous online survey about work at home and duty hours. Programs were selected to represent a range of geographic location, size, and academic status. The survey was administered in May and June 2014. When answering questions about work at home, residents were instructed to think only about patient care and to exclude time spent “studying, preparing for presentations, or doing research.” Our results were analyzed with standard descriptive statistics in SAS 9.3. We used multivariate logistic regression to determine if demographic variables including specialty and training level were associated with reporting working at home.
Results: Of 1591 contacted residents, 535 completed the survey (response rate 34%). Sixty percent of all respondents were men, 60% were Caucasian, 56% were < 30 years old, and 42% were general surgery residents. Respondent level included PGY1 (38%), PGY2 (28%), PGY3 (22%), and PGY4-5 and research years (12%). Most residents reported performing patient care work at home, but did not count this toward their duty hours (88%). Residents worked at home an average of 1-2 hours (35%), 2-5 hours (36%), 5-10 hours (14%), or >10 hours (4%) per week. Work at home included: checking lab and results (92%), reading charts to prepare for a new rotation (87%), reviewing patient vitals (75%), and talking to other residents or attendings (72%). Surgery residents also frequently reviewed charts for upcoming cases (94%) and completed operative reports (65%). Curiosity about patient outcomes (78%), desire to leave the hospital (74%), comfort (66%), and increased time with family (61%) were the most important reasons for working at home. Thirty percent of residents explicitly did work at home to avoid counting it as duty hours. On univariate and multivariate analysis there was no significant relationship between gender, age, race, specialty, or level and likelihood of reporting working at home.
Conclusion: Electronic medical records allow the majority of residents to shift some patient care work from the hospital to home. Most residents in our study reported not recording this time as duty hours despite ACGME guidance to the contrary. Our results indicate that residents’ sense of responsibility for their patients continues after they leave the hospital, perhaps mitigating concerns about a “shift-work mentality.” Given the prevalence of work at home, further research should assess its impact on patient care, resident education, and quality of life.