How do hospitalized patients feel about resident work hours, fatigue, and discontinuity of care? J Gen Intern Med 2008 May;23(5):623-8
Date
02/12/2008Pubmed ID
18264835Pubmed Central ID
PMC2324147DOI
10.1007/s11606-007-0384-0Scopus ID
2-s2.0-42449141848 (requires institutional sign-in at Scopus site) 13 CitationsAbstract
BACKGROUND: Patient-centered care requires that physicians understand patients' perspectives. Since the resident work hour rules were instituted, little information is available about how patients perceive these issues. Our objectives were to explore patients' knowledge, concerns, and attitudes about resident work hours, fatigue, and continuity of inpatient care and to evaluate the association between patients' trust and satisfaction with these concerns and attitudes.
METHODS: We conducted a cross-sectional survey of 134 internal medicine inpatients at 3 institutions including a tertiary care academic health center, a Veterans Affairs medical center, and a private community teaching hospital.
RESULTS: Mean age was 59 (range, 24-90), with 60% men and 70% white. Most patients agreed (50%) or felt neutral (38%) toward resident work hours being limited. Patients estimated that residents worked 60 h per week but thought that they should work no more than 51 h per week (p < .01 for the difference). Twenty-seven percent of patients had some concern about fatigue in the residents, and 28% reported concern about how often hand-offs of care occurred. Factor analysis yielded 3 factors: "worried about discontinuity/fatigue," "attitude toward resident/nurse work hours," and "perceived resident/nurse fatigue." In multivariable analyses, the "worried about fatigue/discontinuity" factor significantly predicted trust and satisfaction, and the "perceived resident/nurse fatigue" factor also predicted satisfaction.
CONCLUSIONS: Some inpatients are concerned about both fatigue in resident physicians and discontinuity of care. This may play a role in trust and satisfaction for patients. Taking steps to design systems to minimize fatigue and discontinuity would be ideal.
Author List
Fletcher KE, Wiest FC, Halasyamani L, Lin J, Nelson V, Kaufman SR, Saint S, Schapira MAuthor
Kathlyn E. Fletcher MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Attitude to Health
Continuity of Patient Care
Cross-Sectional Studies
Female
Hospitals, Community
Hospitals, University
Hospitals, Veterans
Humans
Internship and Residency
Male
Middle Aged
Nurses
Patient Satisfaction
Patients
Personnel Staffing and Scheduling
Physician-Patient Relations
Trust
United States
Work Schedule Tolerance
Workload
