Unintended consequences of a night float system in Paediatric Residency

Abstract

Objectives: Many residency programs implement 'night float' (NF) systems as alternatives to a traditional 24-h call model in an attempt to comply with duty-hour regulations. Research evaluating NF systems has focused primarily on the perspective of the resident with respect to fatigue and quality of life. Understanding the broader consequences of NF models from both trainee and faculty points of view is essential to creating effective and sustainable systems to comply with duty-hour regulations while maximizing patient care, education, and quality of life (QoL).

Methods: This study used qualitative thematic analysis situated in a constructivist paradigm to explore the experience of an NF system by residents and faculty. Semi-structured interviews were conducted with 15 trainees and 3 faculty members at a large academic pediatric hospital to understand their perceptions of an NF call structure compared to the traditional 24-h call schedule.

Results: Three themes were identified: (i) Implications for resident; (ii) Implications for patient and family; and (iii) Implications for curriculum. Eight sub-themes were identified, highlighting both intended and unintended consequences of the NF system.

Conclusions: The NF system resulted in the intended outcomes of decreased fatigue and improved continuity of patient care. Unintended outcomes also occurred, however, including negative effects on assessment and feedback, lack of integration of competencies, and mixed results on resident quality of life. These areas require special attention when designing and implementing NF systems.

Keywords: Hospitalist; Night Float; Pediatric Hospitalist; Pediatric Residency.