Implications of transitioning to a resident night float system in neurosurgery: mortality, length of stay, and resident experience

• Published in: Journal of neurosurgery Vol. 126; no. 4; p. 1269
• Main Authors: Davis, Matthew C, Kuhn, Elizabeth N, Agee, Bonita S, Oster, Robert A, Markert, James M
• Format: Journal Article
• Language: English
• Published: United States 01.04.2017
• Subjects: Academic Medical Centers; Female; Hospital Mortality - trends; Humans; Internship and Residency; Length of Stay - trends; Male; Middle Aged; Neurosurgeons - psychology; Neurosurgery - education; Neurosurgery - methods; Patient Readmission - trends; Retrospective Studies; PGY = postgraduate year; ACGME = Accreditation Council for Graduate Medical Education; UAB = University of Alabama at Birmingham; ANCOVA = analysis of covariance; patient handoff; DRG = diagnosis-related group; length of stay; LOS = length of stay; neurosurgery; patient outcome assessment
• ISSN: 1933-0693
• DOI: 10.3171/2016.5.JNS152585

OBJECTIVE Many neurosurgical training programs have moved from a 24-hour resident call system to a night float system, but the impact on outcomes is unclear. Here, the authors compare length of stay (LOS) for neurosurgical patients admitted before and after initiation of a night float system at a tertiary care training hospital. METHODS The neurosurgical residency at the University of Alabama at Birmingham transitioned from 24-hour call to a night float resident coverage system in July 2013. In this cohort study, all patients admitted to the neurosurgical service for 1 year before and 1 year after this transition were compared with respect to hospital and ICU LOSs, adjusted for potential confounders. RESULTS A total of 4619 patients were included. In the initial bivariate analysis, night float was associated with increased ICU LOS (p = 0.032) and no change in overall LOS (p = 0.65). However, coincident with the transition to a night float system was an increased frequency of resident service transitions, which were highly associated with hospital LOS (p < 0.01) and ICU LOS (p < 0.01). After adjusting for resident service transitions, initiation of the night float system was associated with decreased hospital LOS (p = 0.047) and no change in ICU LOS (p = 0.35). CONCLUSIONS This study suggests that a dedicated night float resident may improve night-to-night continuity of care and decrease hospital LOS, but caution must be exercised when initiation of night float results in increased resident service transitions.