IMPACT OF A NIGHT FLOAT SYSTEM ON HOUSESTAFF SATISFACTION. S. Kripalani 1 , M.V. Williams 1 ; 1 Emory University, Atlanta, GA PURPOSE: In an effort to reduce workload, a night float (NF) rotation was established in July 1999. Three of twelve ward teams were on call each day and stopped admitting patients at 2300. They remained overnight to complete work-ups and cover their own service. From 2300 until 0700, NF teams performed all medical admissions and covered the other 9 teams. Two or three NF teams (consisting of an intern and resident) worked each night. In the morning, they handed-off the new patients to ward teams and attended a teaching conference before going home. We conducted this study to evaluate the impact of the NF system on satisfaction and quality of care. METHODS: Ward residents (WR) and night float staff (NFS) completed a 2-page questionnaire at the end of each month from July 1999 to April 2000. Survey questions focused on the following domains: workload, educational activities, morale, and quality and continuity of care. RESULTS: The overall response rate was 81% (n=92 WR and 51 NFS). WR got an average of 4.5 hours of sleep on call, compared with 2.4 hours the previous year, p < .0001. Nearly all (89%) felt more rested post-call, and 71% thought they could take better care of patients during the day because of the NF system. According to 87% of WR, the workload was significantly better, and 63% had more time for educational activities. Approximately 90% agreed that NF had improved housestaff morale and the overall experience of the ward rotation. Regarding the NF admissions, most WR appeared satisfied with the quality of history and physicals (63%), choice of diagnostic testing (72%), and initial treatment (71%). However, many WR disagreed with the assessment and changed the treatment plan about 25% of the time. One-third expressed some concern that continuity may suffer when patients are handed-off in the morning, but only 2% felt that overall patient care suffered, and 94% were glad that the NF system was in place. Each NF team received a mean of 3.9 admissions per night (range 2-11) and a median of 4.8 crosscover calls, which required about 45 minutes to answer. Nearly 95% of NFS agreed that the overall workload and number of admissions were reasonable. However, only 66% were satisfied with the amount of learning/teaching on the NF rotation. Working nights for a month was difficult for 67% of NFS, and 80% felt it affected their social life. Daytime sleep was often unrestful, afternoon continuity clinics disrupted sleeping schedules, and NFS had limited time with friends and family. Nevertheless, 90% agreed that the month was a positive experience overall, and 96% were glad that the system was in place. CONCLUSION: Residents on the ward teams reported improved morale, increased sleep, more time to read and attend conferences, and better quality of care delivery. In spite of complaints about the nocturnal lifestyle and educational content of the rotation, housestaff on the NF teams favored the system as well. We implemented a clinic-based coaching model using rating forms and observed interviews. The purpose of this study is to describe the use and modification of the rating scales for coaching purposes, and to discuss the variations among specific communication skills by resident year and gender. METHODS: The Calgary-Cambridge Referenced Observation Guides were selected as a teaching tool because of their specificity and ease of use during observed interviews. To provide skill discrimination for each rating item, a 5 point Likert scale was created for each item ranging from poor to excellent performance. After obtaining patient consent, resident physicians were shadowed by the residency behavioral scientist (BRL) for one clinic afternoon or morning, and their skills were rated using the instrument. 25 resident physicians were observed for a total of 48 interviews. Likert scores were dichotomized into excellent (5) and less than excellent (1) (2) (3) (4) categories for each item; and mean scores generated for the following domains: Initiating the session (5 items); Exploration of problems (7 items); Understanding the patient's perspective (5 items); Structuring the consultation (4 items); Building the relationship (7 items); and Explaining and planning (5 items). General Linear Models procedures were used to compare mean differences in domain scores by gender and year of resident training (R1, R2, R3). RESULTS: No significant gender differences were found for any of the domains (p < .05).