APM perspectiveMeasuring Resident Hours by Tracking Interactions with the Computerized Record
Section snippets
Materials and Methods
We aimed to validate self-report of duty hours (and of their distribution within the week) during a busy rotation in the medical intensive care unit using a more objective method: surveillance of all resident interactions with the electronic medical record.
The Internal Medicine Residency Training Program at New York University Langone Medical Center rotates 164 residents through thirteen 28-day blocks per year at the University Hospital and two affiliated institutions. Typically, 2 blocks are
Results
Responding residents reported a total 4383 hours; the electronic medical record surveillance report returned 4062 for these same days, a 7.3% discrepancy. Considering only scheduled days for which time-cards had been submitted, there were 71 opportunities to violate the 80-hour work week rule and the same number of opportunities to violate the standard of 1 day off weekly. There were 154 opportunities to violate the 27-hour rule and 462 opportunities to violate the requirement for 10 hours off
Limitations
Limitations of this study include its performance at a single institution with an advanced electronic medical record and among only those residents who were assigned to the medical intensive care unit of the University Hospital. It is likely that residents rotating in areas where the patients are less ill will interact less frequently with the electronic medical record; underestimates of hours might therefore be greater than in a medical intensive care unit. The extent of additional
Conclusions
Our finding that residents—compared with an independent and objective data source—accurately recorded their own hours and violations must be confirmed in other institutions and especially in less intensive clinical settings. This study suggests a possible alternative to time-cards but also provides validation for their use and therefore supports a method frequently used in published studies to measure the impact of resident duty hours on patient and resident outcomes.
Acknowledgments
The authors thank John Jackson Braider for assistance in editing the article.
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2021, Journal of Surgical EducationCitation Excerpt :Our study validated EHR-based duty hour estimates using GPS-derived duty hours. Shine et al reported a method of using EHR interactions to track medical resident duty hours and validated it with self-reported logs.13 However, their method was not automated and required manual tabulation of data.
Smart-phone Based Geofencing: A Novel Approach to Monitoring Clinical Work Hours in Surgery Residency
2021, Journal of Surgical EducationCitation Excerpt :Most programs rely on electronic or other systems for tracking resident duty hours.9 These initiatives range from time cards, to measuring hours based on time spent using the electronic medical record.10,11 Many of these systems rely on self-reporting, which can be inaccurate due to recall bias, underreporting, or lack of compliance with reporting.9,12,13
Using an anonymous, resident-run reporting mechanism to track self-reported duty hours
2019, American Journal of SurgeryCitation Excerpt :Many programs across the country depend on some form of self-reporting to monitor work hours.12–14 Some studies have found self-reporting to be as accurate as objective data gathered from electronic medical records,15 swiping in and out of hospitals,16 and time-stamped parking data.17 Others, however, have shown that residents tend to underreport their duty hours to program directors and have highlighted the inaccuracy of current reporting mechanisms.18,19
Duty-hours monitoring revisited: Self-report may not be adequate
2013, American Journal of MedicineMeasuring duty hours made simple
2010, American Journal of MedicineThe reply
2010, American Journal of Medicine
Funding: None.
Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.
Authorship: All authors had access to the data and played a role in writing this manuscript.