Inpatient Attending Physician Rotation Duration Study

Pamela Gonzalez Sr Director Clinical Research Office

Status: Completed

Conditions: Inpatient Attending Physician Staffing Model

Treatments: Other: 2-week rotation; Other: 4-week rotation

Study type: Interventional

Funder types: Other

Identifiers

NCT00930111

09-063 Cooker 533

Details and patient eligibility

About

The investigators are testing the effects of a change in teaching attending physicians' rotations (from 4- to 2-week blocks) on patient outcomes (unplanned urgent visits to the health care system, inpatient mortality, and length-of-stay), the educational experiences of residents and medical students and on the quality of the professional lives of the attending physicians.

Full description

Design, Setting, and Participants Cluster randomized crossover noninferiority trial, with attending physicians as the unit of crossover randomization and 4-week rotations as the active control, conducted in a US university-affiliated teaching hospital in academic year 2009. Participants were 62 attending physicians who staffed at least 6 weeks of inpatient service, the 8892 unique patients whom they discharged, and the 147 house staff and 229 medical students who evaluated their performance.

Intervention Assignment to random sequences of 2- and 4-week rotations.

Main Outcome Measures Primary outcome was 30-day unplanned revisits (visits to the hospital's emergency department or urgent ambulatory clinic, unplanned readmissions, and direct transfers from neighboring hospitals) for patients discharged from 2- vs 4-week within-attending-physician rotations. Noninferiority margin was a 2% increase (odds ratio [OR] of 1.13) in 30-day unplanned patient revisits. Secondary outcomes were length of stay; trainee evaluations of attending physicians; and attending physician reports of burnout, stress, and workplace control.

Enrollment: 62 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• Attending physician on inpatient general medicine wards of Stroger Hospital, Chicago, IL

Exclusion criteria

• Scheduled for less than 6 weeks during the 2009 academic year

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

---

62 participants in 2 patient groups, including a placebo group

2 weeks

Active Comparator group

Description:

Attending physicians are physician-of-records for traditional inpatient ward team (housestaff and medical students) for 2 weeks.

Treatment:

Other: 2-week rotation

4 weeks

Placebo Comparator group

Description:

Attending physicians are physician-of-records for traditional inpatient ward team (housestaff and medical students) for 4 weeks.

Treatment:

Other: 4-week rotation