Unintended consequences of a night float system in Paediatric Residency

Area of Science:

• Medical Education
• Healthcare Management
• Patient Safety

Background:

• Residency programs use night float (NF) systems to meet duty-hour regulations.
• Previous research on NF systems primarily focused on resident fatigue and quality of life (QoL).
• A comprehensive understanding of NF systems from both trainee and faculty perspectives is crucial for optimizing patient care and education.

Purpose of the Study:

• To explore the experiences of residents and faculty with night float (NF) systems.
• To identify the intended and unintended consequences of NF systems on patient care, education, and QoL.
• To inform the development of effective and sustainable NF models.

Main Methods:

• Qualitative thematic analysis using a constructivist paradigm.
• Semi-structured interviews with 15 trainees and 3 faculty members.
• Exploration of perceptions of NF call structure versus traditional 24-hour call.

Main Results:

• NF systems led to decreased resident fatigue and improved patient care continuity.
• Identified themes included implications for residents, patients/families, and curriculum.
• Eight sub-themes revealed both intended and unintended consequences of the NF system.

Conclusions:

• NF systems achieve intended benefits like reduced fatigue and better care continuity.
• Unintended outcomes include negative impacts on assessment, feedback, competency integration, and variable effects on resident QoL.
• Special attention is needed for these unintended consequences when designing and implementing NF systems.