Feasibility of and barriers to continuity of care in US general surgery residencies with an 80-hour duty week

Abstract

Background: The current level of continuity of care for following up a single patient through preoperative evaluation, surgery, and postoperative care is unknown.

Methods: A survey of residents was performed, asking for their best guess regarding the number of patients seen for 6 common and 4 uncommon surgeries, and ranking barriers to continuity of care. The length of time to achieve single-patient continuity of care in 5 patients was derived as well as the creation of odds ratios for the barriers.

Results: A total of 274 residents (56 programs) completed surveys. Residency length was 7 years for common surgeries and 9 for complex surgeries. The 30-hour work restrictions, inability to attend clinic, and floor/ward duties were the barriers to continuity of care. These data were unaffected by type of program, the presence of a night float system, or residency year.

Conclusions: Achieving the level of continuity of care used in this article will require a radical change in the length or structure of general surgery residency programs.