Decision Support Tool Improves Real and Perceived Anesthesiology Resident Relief Equity

Area of Science:

• Medical Education
• Anesthesiology Resident Training
• Healthcare Operations

Background:

• Accreditation Council of Graduate Medical Education mandates monitoring of resident hours but lacks tracking for daily work patterns or duty hour equity.
• Absence of a defined system for operating room (OR) clinical duty relief led to inequitable distribution and affected resident morale.
• An institution-specific need for a structured system to manage resident relief from weekday OR duties was identified.

Purpose of the Study:

• To develop and implement an automated decision support tool (DST) to standardize and improve equitable decision-making for resident clinical relief.
• To assess the impact of the DST on both actual and perceived relief equity among residents.
• To address the lack of systematic monitoring of daily work patterns and duty hour equity in resident training.

Main Methods:

• A DST was developed to generate a prioritized relief list of non-call residents who worked in the OR past 5 PM the previous day.
• Actual relief equity was assessed by tracking residents working past 5:30 PM on two consecutive weekdays, adjusted for OR availability.
• Perceived relief equity was evaluated using pre- and post-implementation questionnaires administered to residents.

Main Results:

• Implementation of the DST significantly decreased the percentage of residents held for two consecutive weekdays (1.33% to 0.43%) and on any given day (18.09% to 12.64%).
• Segmented regression analysis confirmed a reduction in consecutive late shifts post-DST implementation, independent of OR volume.
• Resident surveys showed a significant improvement in perceived equitable relief decision-making (60% to 94%) and fewer instances of working past 5 PM.

Conclusions:

• A DST systematizing the relief process for anesthesiology residents effectively reduced the frequency of prolonged work hours on consecutive days.
• The DST demonstrably improved residents' and senior residents' perceived ability to make equitable relief decisions.
• The DST's success suggests potential for broader application in resident education for enhanced monitoring and support of OR assignments.