Resident productivity: does shift length matter?

BACKGROUND

It has been established that residents are able to evaluate more patients per hour as they progress through training. However, it is unknown if shift length influences resident productivity.

OBJECTIVES

The aim of this study is to assess whether there is a difference in second-year resident productivity as a function of shift length.

METHODS

This is a retrospective chart review of patients evaluated in the emergency department (ED) by second-year residents in a 65,000 volume center; 9- and 12-hour shifts were included. Nine-hour shifts provide a 1-hour overlap, such that three 9-hour shifts provide 24 hours of resident coverage. Shifts on weekly conference day were excluded. A patient was determined as having been evaluated by a resident if the resident initiated care on the patient and dictated the chart. Data were analyzed using 2-tailed t test.

RESULTS

A total of 193 nine-hour shifts and 90 twelve-hour shifts met inclusion criteria. Residents working 12-hour shifts evaluated 1.06 patients per hour, and residents working 9-hour shifts evaluated 1.15 patients per hour (95% confidence interval, 0.031-0.151). In an ED with 120 hours of resident coverage per day, this results in 10 additional patients seen by residents working 9-hour shifts. In our department with 9 ED months in the second year of residency, this results in 180 additional patient encounters per resident during that year.

CONCLUSIONS

Shorter shift lengths appear to result in more patients evaluated per hour by second-year residents and an increase in patient encounters.