Changing the Presentation of Overnight Admissions to Improve Teaching Rounds

Increased use of night float systems for overnight admissions in internal medicine has led to trainees presenting newly admitted patients that they did not personally admit in many US residency programs.

To examine the impact of an alternative presentation model for patients admitted overnight by another resident, with the theory that this might improve efficiency and educational experience.

The pilot was done on the general medicine teams of an academic medical center.

Four teams participated, comprised of 12 residents and 4 attendings in total.

For this pilot, the attending and supervising resident were asked to review overnight admissions before the rounds, use a streamlined patient presentation, and encourage critical review of the initial clinical reasoning. Teams used the traditional presentation for 1 week and then the new model for the subsequent 2 weeks of a 3-week rotation.

Fifteen of 16 participants returned the surveys, and they generally rated the new approach superior to the traditional approach. Time studies found it time neutral.

Both faculty and trainees broadly preferred the new approach for presenting overnight admissions. This approach required no extra funding, was simple to implement, and did not increase rounding time.