The R.E.S.T. Initiative: A Pilot Program to Enhance Resident Performance by Taking Breaks On-Shift

This study was designed to assess the impact of a break-taking initiative for resident physicians to encourage nutrition and patient note writing during their shift in the emergency department (ED). The primary objective was to determine if the intervention improved hunger, fatigue, incomplete documentation in the medical record, and post-shift exit time.

We introduced an intervention titled the R.E.S.T. initiative, which consisted of encouraging residents to take a 15-min break during their shift to eat and write notes, providing food in the resident break room, and encouraging disposition-focused rounds with the attending physician approximately 1 h prior to the end of shift. An ecologic momentary assessment (EMA) tool was used to assess residents' hunger, fatigue, note burden, and participation in the intervention at three timepoints throughout their ED shift. Pre-intervention baseline data were collected as well. Mixed-effects models were used to assess changes pre- and post-intervention. A post-intervention survey collected feedback and opinions on the intervention from both faculty and residents.

A total of 44 residents participated in the intervention. On-shift break frequency improved from 19% to 56% during the intervention (p < 0.001). Post-shift hunger and fatigue scores improved significantly during the intervention (OR 4.10, p < 0.001 and OR 2.53, p = 0.001, respectively), without a significant change in the number of new patients seen nor patients signed out to the oncoming team. All faculty and residents reported that there were no adverse effects on patients as a result of the intervention. Residents felt the breaks improved their efficiency and the quality of care they provided.

An intervention to encourage breaks for eating and charting, along with disposition-focused rounds near the end of shift, improved hunger and fatigue in emergency medicine residents without negatively impacting patient safety or perceived resident efficiency.