SHM Converge Scientific Abstract ePoster Gallery-Monitoring Work-Hours With Innovative Tools Following a Teaching Service Restructure

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The document describes a quality-improvement effort to reduce internal medicine trainee work-hour violations after repeated ACGME citations. In July 2021, an inpatient teaching service was restructured to better comply with the 80-hour workweek requirement. The new model included fewer teams, a day/night system, standardized sign-out times, shorter admitting hours, and more days off per rotation.<br /><br />To measure work hours more reliably and proactively, the team used three methods: a real-time dashboard based on EMR login data, pager forwarding data, and retrospective self-reported hours in MedHub. These tools allowed the program to monitor workload in near real time and intervene before violations occurred. Interventions included additional coaching or clinical support, reducing new patient volume, early dismissal, or giving an extra day off.<br /><br />The monitoring system also helped identify key drivers of violations, including high documentation burden and certain call-cycle days, such as when a resident was the sole provider on interns’ day off. Pager forwarding data showed that sign-out times generally stayed close to target times.<br /><br />Results showed a substantial improvement in compliance. Weekly 80-hour violations dropped from an average of 3.8 before the restructure (February–June 2021) to 0.93 after the restructure (July 2021–September 2022), a statistically significant reduction (p = 0.001). No violations were reported for exceeding 80 hours over a 4-week period during the monitored February–October span.<br /><br />Overall, the study concludes that thoughtful service redesign combined with innovative, real-time monitoring can both reduce trainee work hours and enable just-in-time interventions to prevent future violations.

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 Innovations

Concept Work Hours

Concept Work-hour violation

Concept ACGME Work-Hour Requirement

Concept EMR login hours

Concept Documentation Burden

Distinguished Non-Finalist

Presenter Organization University of California, San Francisco

Presenting Author Molly A. Kantor

Track Education

Keywords

internal medicine

work-hour violations

ACGME

quality improvement

80-hour workweek

real-time dashboard

EMR login data

pager forwarding

MedHub

service redesign

Work Hours

Work-hour violation

ACGME Work-Hour Requirement

EMR login hours

Documentation Burden