Inpatient Attending Physician Rotation Duration Study

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Inpatient Attending Physician Rotation Duration Study

Conditions
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Inpatient Attending Physician Staffing Model

Intervention / Treatment
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* Other: 2-week rotation
* Other: 4-week rotation


Participation Criteria
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Eligibility Criteria
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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
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 2 weeks<br>Attending physicians are physician-of-records for traditional inpatient ward team (housestaff and medical students) for 2 weeks. | Other: 2-week rotation<br>* Attending physician is assigned to a 2-week rotation.<br>|
| Placebo Comparator: 4 weeks<br>Attending physicians are physician-of-records for traditional inpatient ward team (housestaff and medical students) for 4 weeks. | Other: 4-week rotation<br>* Attending physician is assigned to a 4-week rotation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patients' unplanned urgent visits to the health care system. | Number pf non-scheduled patient encounters documented in the EHR | 30 days after discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Resident physicians' evaluation of attending physicians' performance. | Self administered performance electronic evaluations - validated tool | During 14 or 28 day rotations | 
| Medical students' evaluations of attending physicians' performance. | Self administered performance electronic evaluations | During 14 or 28 day rotations | 
| Urgent visits to health care system among attending physicians' outpatient panel (if attending physician has an outpatient panel) | Number pf non-scheduled patient encounters documented in the EHR | During and 14 to 28 days after provider's rotation | 
| Attending physicians' work-life balance, perceived stress, and perceived burn-out. | Self administered confidential Burnout assessment survey based on Conceptual Model of Burnout, Perceived Stress Scale & Maslach Burnout Inventory Human ServiceSurvey and a single item measure from the Notional Job Burnout Survey. | During 14 to 28 day rotations | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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inpatient, hospitalists, residency, job satisfaction, burnout, professional, professional practice, medical education