SHM Converge Scientific Abstract ePoster Gallery-Impact of Inpatient Medicine Wards Restructure on Trainee Work Hours

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The document describes a quality improvement intervention on an inpatient internal medicine teaching service aimed at reducing trainee work-hour violations under ACGME rules. After repeated citations for exceeding the 80-hour limit, the program restructured the service by moving from a 28-hour call model to a day/night system, shortening admitting hours, standardizing sign-out times, changing rotation length from 1 month to 28 days, and adding an extra day off per rotation.<br /><br />Work hours were tracked using mandatory self-reported logs in Medhub and analyzed for interns and residents before and after the change. The main outcome was a substantial reduction in weekly work-hour violations: the average fell from 3.8 violations per week before the restructure to 0.93 afterward, which was statistically significant. There were no instances of trainees averaging more than 80 hours per week over 4 weeks before or after the change.<br /><br />The restructure was also associated with a significant drop in the average census on the teaching service, from 78.8 patients in academic year 2020–2021 to 70.6 in 2021–2022. Although reducing census was not the explicit goal, the authors suggest the decrease likely resulted from shorter admitting hours on long-call days and that patients were shifted to non-teaching teams rather than removed from the system.<br /><br />Overall, the intervention appears to have markedly improved compliance with work-hour regulations. The authors conclude that the new structure was effective, but further study is needed to determine which specific components drove the improvement and whether the gains can be maintained if patient volume increases.

Asset Subtitle

Molly A. Kantor

Meta Tag

Author List Adeena Khan, Anjali Thakkar, Bradley Monash, Fangdi Sun, Hope Caughron, Lekshmi Santhosh, Molly A. Kantor, Timothy Dyster

Category Research

Concept ACGME Work-Hour Requirement

Concept Inpatient Teaching Service

Concept Work Hours

Concept Teaching Service Restructuring

Concept Weekly 80-Hour Violation

Distinguished Non-Finalist

Presenter Organization University of California, San Francisco

Presenting Author Molly A. Kantor

Track Education

Keywords

ACGME

work-hour violations

inpatient internal medicine

teaching service

day/night system

resident duty hours

Medhub logs

rotation restructure

census reduction

quality improvement

ACGME Work-Hour Requirement

Inpatient Teaching Service

Work Hours

Teaching Service Restructuring

Weekly 80-Hour Violation