Document Detail


Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial.
MedLine Citation:
PMID:  23212497     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
CONTEXT: Data are sparse on the effect of varying the durations of internal medicine attending physician ward rotations.
OBJECTIVE: To compare the effects of 2- vs 4-week inpatient attending physician rotations on unplanned patient revisits, attending evaluations by trainees, and attending propensity for burnout.
DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized crossover noninferiority trial, with attending physicians as the unit of crossover randomization and 4-week rotations as the active control, conducted in a US university-affiliated teaching hospital in academic year 2009. Participants were 62 attending physicians who staffed at least 6 weeks of inpatient service, the 8892 unique patients whom they discharged, and the 147 house staff and 229 medical students who evaluated their performance.
INTERVENTION: Assignment to random sequences of 2- and 4-week rotations.
MAIN OUTCOME MEASURES: Primary outcome was 30-day unplanned revisits (visits to the hospital's emergency department or urgent ambulatory clinic, unplanned readmissions, and direct transfers from neighboring hospitals) for patients discharged from 2- vs 4-week within-attending-physician rotations. Noninferiority margin was a 2% increase (odds ratio [OR] of 1.13) in 30-day unplanned patient revisits. Secondary outcomes were length of stay; trainee evaluations of attending physicians; and attending physician reports of burnout, stress, and workplace control.
RESULTS: Among the 8892 patients, there were 2437 unplanned revisits. The percentage of 30-day unplanned revisits for patients of attending physicians on 2-week rotations was 21.2% compared with 21.5% for 4-week rotations (mean difference, -0.3%; 95% CI, -1.8% to +1.2%). The adjusted OR of a patient having a 30-day unplanned revisit after 2- vs 4-week rotations was 0.97 (1-sided 97.5% upper confidence limit, 1.07; noninferiority P = .007). Average length of stay was not significantly different (geometric means for 2- vs 4-week rotations were 67.2 vs 67.5 hours; difference, -0.9%; 95% CI, -4.7% to +2.9%). Attending physicians were more likely to score lower in their ability to evaluate trainees after 2- vs 4-week rotations by both house staff (41% vs 28% rated less than perfect; adjusted OR, 2.10; 95% CI, 1.50-3.02) and medical students (82% vs 69% rated less than perfect; adjusted OR, 1.41; 95% CI, 1.06-2.10). They were less likely to report higher scores of both burnout severity (16% vs 35%; adjusted OR, 0.39; 95% CI, 0.26-0.58) and emotional exhaustion (19% vs 37%; adjusted OR, 0.45; 95% CI, 0.31 to 0.64) after 2- vs 4-week rotations.
CONCLUSIONS: The use of 2-week inpatient attending physician rotations compared with 4-week rotations did not result in an increase in unplanned patient revisits. It was associated with better self-rated measures of attending physician burnout and emotional exhaustion but worse evaluations by trainees.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00930111.
Authors:
Brian P Lucas; William E Trick; Arthur T Evans; Benjamin Mba; Jennifer Smith; Krishna Das; Peter Clarke; Anita Varkey; Suja Mathew; Robert A Weinstein
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  308     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2199-207     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Cook County Health and Hospitals System and Rush Medical College, 1900 W Polk St, Room 520, Chicago, IL 60612, USA. brian_lucas@rush.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00930111
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