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

Area of Science:

• Medical Education and Training
• Emergency Medicine
• Physician Well-being

Background:

• Emergency department (ED) resident physicians face demanding shifts with potential for high hunger and fatigue levels.
• Inadequate nutrition and documentation during shifts can negatively impact resident performance and patient care.
• Existing initiatives often overlook the critical need for structured breaks for eating and documentation.

Purpose of the Study:

• To assess the impact of a novel break-taking initiative on emergency medicine residents.
• To determine if the intervention improved resident hunger, fatigue, and documentation completeness.
• To evaluate the effect of the initiative on post-shift exit times and patient safety.

Main Methods:

• Implementation of the R.E.S.T. initiative, encouraging 15-minute breaks for nutrition and note writing.
• Provision of food in the resident break room and promotion of disposition-focused rounds.
• Utilized an ecologic momentary assessment (EMA) tool to track hunger, fatigue, and note burden; analyzed pre- and post-intervention data using mixed-effects models.

Main Results:

• On-shift break frequency significantly increased from 19% to 56% (p < 0.001).
• Post-shift hunger and fatigue scores showed significant improvement (OR 4.10, p < 0.001 and OR 2.53, p = 0.001, respectively).
• No significant changes in patient volume or sign-outs; no adverse patient effects reported; residents perceived improved efficiency and care quality.

Conclusions:

• The R.E.S.T. initiative effectively improved hunger and fatigue among emergency medicine residents.
• Encouraging breaks for nutrition and charting, coupled with disposition-focused rounds, enhances resident well-being.
• The intervention demonstrated no negative impact on patient safety or perceived resident efficiency, supporting its broader adoption.