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(Chest. 2006;130:625-626.)
© 2006 American College of Chest Physicians

Work Shift Model for Housestaff in the Medical ICU

Janet M. Shapiro, MD and Ethan D. Fried, MD

St. Luke’s-Roosevelt Hospital Center New York, NY

Correspondence to: Janet M. Shapiro, MD, St. Luke’s Hospital, Division of Medicine, Department of Pulmonary and Critical Care Medicine, St. Luke’s Hospital-MU 316, 1111 Amsterdam Ave, New York, NY 10025; e-mail: jshapiro{at}chpnet.org

To the Editor:

We read with interest the article by Afessa et al (December 2005)1 describing the institution of a 14-h work shift for housestaff in the medical ICU (MICU). Another study2 found a reduction in the rate of serious medical errors when interns worked shorter MICU shifts. In the article by Afessa et al1 no significant differences in patient mortality or hospital length of stay were found, and no differences in the medical knowledge of house officers assessed by a postrotation examination were found.1

In August 2004, we instituted a night float system in our MICU, which is a unit in a university-affiliated teaching hospital in New York City with 12 to 15 beds. Each of the four intern/resident pairs in the MICU spends 1 week as the night float team, working from 9:00 PM to 10:00 AM. The night float team receives a detailed sign-out form at 9:00 PM from the day team and stays for morning rounds.

Concerns about night float teams in the ICU have focused on the discontinuity of care for the most severely ill patients. Our experience has been extremely positive in many qualitative ways, as follows:

  1. We find house officers alert and energetic, having received adequate rest.
  2. The 9:00 PM evening sign out between house officers has offered several benefits. The house officers’ sense of responsibility is strengthened as they reappraise the day’s events and give opinions to each other about new MICU admissions. A computer-printed sign-out system has been started by the housestaff in order to transfer all current information. We have not found lapses in patient care related to lack of continuity.
  3. Each day’s MICU admissions are shared between the day and night call teams, so the house officers have more time to read about their cases. Thus, we feel that improved education and interaction have resulted.
  4. The system has strengthened the team approach. The current critical care environment poses an increased workload and case complexity that mandates the shared sense of duty of the entire MICU team.
  5. The residency program has been in compliance with work-hour regulations.

The success in the ICU of limitations on housestaff work hours and night float systems show that we can accomplish excellence in patient care while working to improve safety and education for our trainees.

Footnotes

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

References

  1. Afessa, B, Kennedy, CC, Klarich, KW, et al (2005) Introduction of a 14-hour work shift model for housestaff in the medical ICU. Chest 128,3910-3915[Abstract/Free Full Text]
  2. Landrigan, CP, Rothschild, JM, Cronin, JW, et al Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med 2004;351,1838-1848[Abstract/Free Full Text]




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