Plastic Surgery Nightfloat: A Study on Wellness, Burnout, and Duty Hours Compliance
Bao Tram Nghiem, MD, Nicholas A. Wingate, MD, Elaina Chen, MD.
University of Rochester, Rochester, NY, USA.
BACKGROUND: Resident education continues to evolve with the national work-hour mandate, with many general and some plastic surgery programs implementing a nightfloat system. This study investigates the effect of nightfloat on resident education and patient care as perceived by both plastic surgery trainees and attending surgeons.
METHODS: Nightfloat was initiated in July 2017 in our plastic surgery division, which shares coverage of hand and facial trauma at four high-volume urban hospitals. Two surveys were administered to current residents and attendings prior to and 12 months after initiation of nightfloat: (a) ten question 10-point Likert scale (1 = strongly disagree, 10 = strongly agree) survey that assessed resident quality of life (QoL), education, patient care and (b) validated Maslach Burnout Inventory (MBI). Two-tailed t-tests were used to assess differences between pre- and post-implementation and resident versus attending perceptions.
RESULTS: With 100% resident and 50-100% attending response rate (varying by survey), respondents averaged between 8.0-8.9 (10 = strongly agree) rating that nightfloat would improve duty hour compliance, wellness, and patient safety, while decreasing fatigue. Respondents averaged between 7.0-7.9 in agreeing it would improve education and academic productivity. There was a general albeit not strongly positive agreement (6.0-6.9) that nightfloat would improve operative experience, communication, and continuity of care. While both believed nightfloat would improve patient care, attendings more strongly believed the system would improve patient safety (attendings 9.3±0.6, residents 7.6±1.7, p = 0.02). There was no statistically significant difference in pre- versus post-implementation surveys. On the MBI, there was no difference between level of emotional exhaustion (pre mean 2.7±1.0, post 2.6±1.3, general population 2.31±1.2) and depersonalization (pre 2.2±1.2, post 2.2±1.2, population 1.7±1.2) between residents and attendings compared to the general population. However, there was a significantly higher level of personal accomplishment amongst residents and attendings (pre 4.7±0.6, post 4.9±0.8) compared to the public (4.3±0.9) (p-value 0.03, 0.02 respectively).
CONCLUSION: Both plastic surgery residents and attendings believe nightfloat has multiple beneficial effects across all categories, which remained unchanged 12 months after initiation. Contrary to other studies, nightfloat was not perceived as detrimental to continuity of care or operative experience. With our expanding staff compliment and operative volume, there was no difference in weekly work hours (pre 62.5±5.2h/week averaged over 1 year prior to nightfloat, post 63.6±5.6), which may explain why nightfloat does not detract from resident education. This study can encourage other programs to adopt a nightfloat system for its broadly positive outcomes.
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