Effects of a night-float system on resident activities and parent satisfaction
T. A. Lieu, C. B. Forrest, N. J. Blum, D. Cornfeld and R. A. Polin
Division of General Pediatrics, University of Pennsylvania, Philadelphia.
Night-float systems have recently been proposed as a way to reduce resident
stress resulting from irregular sleep patterns. We prospectively evaluated
the effects of a night-float system in which designated residents relieved
on-call senior residents and interns of routine admissions of patients in
medically stable condition during the late-night period (11 PM to 7 AM).
Senior residents (3.7 vs 2.4 hours) and interns (3.7 vs 3.2 hours) reported
sleeping more under the night-float system than under the traditional
system. The night-float system did not affect residents' overall ratings of
call nights. Educators who reviewed medical records agreed with residents'
decisions about patients' appropriateness for admission using the
night-float system in 95 (81%) of 117 cases. When educators disagreed with
residents, the most common reasons were the patient's potential educational
value or medical instability. The night-float system did not affect
interns' ratings of the educational value of late-night admissions or
parents' ratings of satisfaction with medical care. We conclude that the
night-float system can increase resident sleep with little cost to parent
satisfaction, but standards for selective use may be needed to avoid
compromising patient care and resident education.
