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Implementation of an Intern Night Float Rotation in a Neurosurgery Residency Program: Perspectives on Patient Safety
Grace Y Ng1, Mercy H Mazurek1, Kelly Cruise1
1Department of Neurosurgery, Mass General Brigham, Boston, Massachusetts; Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts.
Objective:
Traditional 24-hour call systems in surgical training often result in educational fragmentation, with post-call days causing interruptions in operative experience, particularly for senior residents. By contrast, night float systems may help reduce interruptions. This study evaluates the implementation of an intern night float rotation in a neurosurgery residency program and assesses perspectives on educational value and patient safety.
Design, Setting, And Participants:
An intern night float system was implemented at Massachusetts General Hospital (a tertiary care center) from April to June 2024. Interns provided in-house overnight coverage, managing >50% of admitted neurosurgery patients. Senior residents on home call provided supervision, performed procedures overnight as needed, and subsequently returned for a regular operative experience the following day. Participants' perspectives were evaluated through Likert-scale surveys administered to attending faculty (n = 5), senior residents (n = 3), junior residents (n = 3), and neuroscience nursing staff (n = 23). Interns (n = 6) completed retrospective open-ended surveys. Outcomes included perceived patient safety, educational value, and nursing satisfaction with communication.
Results:
Improvement in perceived patient safety was rated highly by faculty/residents (median 5/5) and nursing staff (median 4/5). Faculty/residents also rated educational value highly (median 5/5), with 100% agreeing or strongly agreeing that the rotation provides valuable learning for residents. Qualitative responses highlighted accelerated intern readiness for PGY-2 responsibilities and protected operative time for senior residents. Nursing staff reported improved ability to escalate concerns (78% agreement) and better response times (78% agreement) after the implementation of the night float rotation. More variability was observed in nursing responses regarding appropriate triage of pages (61% agreement, 39% neutral).
Conclusions:
An intern night float rotation received positive feedback from faculty, residents, interns, and nursing staff regarding patient safety. The rotation provided educational opportunities for interns and improved operative experience for senior residents. This study suggests that intern night float models can align educational needs across training levels without affecting perceived patient safety.