The resident work‐hour rules were implemented by the Accreditation Council for Graduate Medical Education to address the patient safety problems associated with physician fatigue, but they do not take into account the discontinuity of care that often results from decreasing resident work hours. Discontinuity of care is important to both academic and community hospitalists — regardless of whether they work with residents — because handoff of care (and therefore discontinuity) is a defining characteristic of our specialty. We sought to explore patients' knowledge, concerns, and attitudes about resident work hours, fatigue, and continuity of inpatient care and to evaluate the association of patients' trust and satisfaction with these concerns and attitudes.
We conducted a cross‐sectional survey of medical inpatients at 3 diverse institutions: a tertiary‐care hospital associated with a freestanding medical college, a Veterans Affairs hospital, and a private community teaching hospital. Participants were eligible if they were over 18 years old, able to speak English, gave consent, and were going to be discharged within 24 hours of the survey. After informed consent was obtained, patients were given a 7‐page survey that contained instructions and detailed definitions of team members (eg, medical students, residents, attendings). The survey had both Likert‐type and short‐answer questions. The institutional review boards at all 3 institutions approved this study.
Response rate was 66%. Mean age was 59 years (range 24‐90 years), 60% were male and 70% were white. Most patients agreed with (50%) or were neutral about (38%) resident work hours being limited. Patients estimated that residents worked 60 hours per week but thought that they should work no more than 51 hours per week (P < .01 for the difference). Resident fatigue was of some concern to 27% of patients, and 28% reported concern about how often handoffs of care occurred. Factor analysis, a statistical approach to identifying survey items that represent an underlying theme or construct, yielded 3 factors: worried about discontinuity/fatigue (Cronbach alpha = 0.89), attitude toward resident/nurse work hours (alpha = 0.69), and perceived resident/nurse fatigue (alpha=0.85). In multivariable analyses, only the worried about fatigue/discontinuity factor significantly predicted trust (beta = ‐0.579, P < .05) and satisfaction (OR = 0.18, P < .05).
A sizable minority of inpatients are concerned about both fatigue in resident physicians and discontinuity of care. This concern may play a role in determining how much trust and satisfaction patients have. Because patients cared for by hospitalists may have similar concerns about discontinuity, taking steps to design systems to minimize both fatigue and discontinuity would be ideal.
K. E. Fletcher, None; F. C. Wiest, None; L. Halasyamani, None; J. Lin, None; V. Nelson, None; S. R. Kaufman, None; S. Saint, None; M. Schapira, None.