Implications of transitioning to a resident night float system in neurosurgery: mortality, length of stay, and resident experience

Implications of transitioning to a resident night float system in neurosurgery: mortality, length of stay, and resident experience
Matthew C. DavisMD1, Elizabeth N. KuhnMD1, Bonita S. AgeePhD, MPH1, Robert A. OsterPhD2 and James M. MarkertMD, MPH1

1Department of Neurosurgery and

2Center for Clinical and Translational Sciences, University of Alabama at Birmingham, Alabama

INCLUDE WHEN CITING Published online July 8, 2016; DOI: 10.3171/2016.5.JNS152585.

Correspondence Matthew C. Davis, Department of Neurosurgery, University of Alabama at Birmingham, 1720 Second Ave. South, FOT 1062. Birmingham, AL 35294-3410. email:
Journal of Neurosurgery
Pages. 1-9

(Issue publication date: July 2016)
DOI: 10.3171/2016.5.JNS152585

Many neurosurgical training programs have moved from a 24-hour resident call system to a night float system, but the impact on outcomes is unclear. Here, the authors compare length of stay (LOS) for neurosurgical patients admitted before and after initiation of a night float system at a tertiary care training hospital.

The neurosurgical residency at the University of Alabama at Birmingham transitioned from 24-hour call to a night float resident coverage system in July 2013. In this cohort study, all patients admitted to the neurosurgical service for 1 year before and 1 year after this transition were compared with respect to hospital and ICU LOSs, adjusted for potential confounders.

A total of 4619 patients were included. In the initial bivariate analysis, night float was associated with increased ICU LOS (p = 0.032) and no change in overall LOS (p = 0.65). However, coincident with the transition to a night float system was an increased frequency of resident service transitions, which were highly associated with hospital LOS (p < 0.01) and ICU LOS (p < 0.01). After adjusting for resident service transitions, initiation of the night float system was associated with decreased hospital LOS (p = 0.047) and no change in ICU LOS (p = 0.35).

This study suggests that a dedicated night float resident may improve night-to-night continuity of care and decrease hospital LOS, but caution must be exercised when initiation of night float results in increased resident service transitions.

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