Clinical trial NCT00930111: Inpatient Attending Physician Rotation Duration Study
Official title: Inpatient Attending Physician Rotation Duration Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Inpatient Attending Physician Staffing Model
Keywords: inpatient
hospitalists
residency
job satisfaction
burnout, professional
professional practice
medical education
Lead sponsor: Cook County Health
Sponsor class: OTHER_GOV
First posted: 2009-06-30
Enrollment: 62
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Patients' unplanned urgent visits to the health care system.
timeFrame: 30 days after discharge
Secondary outcomes:
measure: Resident physicians' evaluation of attending physicians' performance.
timeFrame: During 14 or 28 day rotations
measure: Medical students' evaluations of attending physicians' performance.
timeFrame: During 14 or 28 day rotations
measure: Urgent visits to health care system among attending physicians' outpatient panel (if attending physician has an outpatient panel)
timeFrame: During and 14 to 28 days after provider's rotation
measure: Attending physicians' work-life balance, perceived stress, and perceived burn-out.
timeFrame: During 14 to 28 day rotations
Other outcomes:
Locations:
city: Chicago
country: United States
facility: Stroger Hospital of Cook County
state: Illinois
Study officials:
affiliation: Cook County Health
name: Brian Lucas, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Lucas BP, Trick WE, Evans AT, Mba B, Smith J, Das K, Clarke P, Varkey A, Mathew S, Weinstein RA. Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial. JAMA. 2012 Dec 5;308(21):2199-207. doi: 10.1001/jama.2012.36522.