Forty-two residents of 86 residents (48%) responded to the survey. Survey response rates throughout this process remained at 48%. 24 residents (57.1%) were female residents; 25 residents (59.6%) were in the third year of training (PGY-3) and 17 (40.4%) residents were in the fourth year of training (PGY-4) as shown in Table 1.
Perceptions of the impact of the Night Float system
Regarding the general well-being, the analysis showed that the residents perceived significantly more negative impact of the 24-oncall system on their general well-being compared to the NF system (general effects on health, restriction to physical activity, impairment to their circadian rhythm, overall fatigue and physical illness episodes, as well as more need to consume stimulants like coca cola and coffee), p ˂ 0.001. However, the NF system was associated significantly with enhanced energy levels than their working with the 24-hour on-call system, p=0.041.
Nonetheless, the perception of potential for harm for the two on-call systems was measured with two indicators. The analysis showed that the perception of potential harm with the 24-hour on-call system was significantly higher .
However, in terms of conflicting potential and resilience effects, the two on-call systems showed equivalent results that allowed to trade off on-call shifts with other residents, p=0.830. However, the residents found the 24-hour on-call system had significantly less permissive (access) to free time to accomplish errands, less family friendly and more restrictive to residents to do research than the NF on-call system (see Table 2).
With regards to the indicators of resident’s relationships with others, the analysis showed that residents significantly felt more isolated in the 24-hours on-call system, but they had significantly better social relationships in NF system, p˂ 0.001.
Ability to deliver quality health care
Importantly, the perception of the impact of these on call systems on the quality of delivered healthcare services by the residents to their patients were measured with four indicators. The data showed that the residents perceived that they were significantly less alert during the 24-hour on-call shifts in comparison with the NF system. Meanwhile, the residents perceived the 24-hour on-call system had significantly more association with preventable medical error density, more near missed errors, and more fatigue that impacted their patients care quality.
In regard to the impact of the two on-call systems on aspects of residents’ expertise, the residents perceived that with the 24-hour on-call system they would significantly miss more important diagnoses of their patients, less ability to manage complex medical issues, less accurate medical handovers and less accountability to patients care, p ˂ 0.001 in comparison to the NF system. As shown in the Table 2.
Medical education experience
Table 2 displays the residents’ responses on the aspects of emotional burden, efficiency of work, education, skills, learning ability, supervision, experiencing interruptions during rotations and post on-call. The analysis of the emotional burden on the residents showed that the residents had experienced significantly greater interaction and communication with their patients during the NF on-calls compared with their 24-hour on-call system. However, the data showed that the two on-call systems had nearly equivalent sensitivity to social issues related to their patients care and care planning like cultural and gender sensitivities, P=0.486. Moreover, the analysis of the indicators of work efficiency showed that the residents had perceived significantly less multitasking ability, less hand over efficiency and less ability to attend pager buzzes during the 24-hour on-calls system compared to the NF on-calls, p ˂ 0.001 each respectively.
In addition, the teaching of junior residents and clerks were significantly less timely permissive and more energy consuming with the 24-hour on-call system than when they worked during the NF shift. However, their 24-hour on-call shifts were highlighted with less confidence to teach, less efficacy on teaching management of unstable patients, and teaching skills on running codes and managing patients in emergencies. The indicators of skillfulness, had suggested that residents were less confidence with doing medical procedures. Also, had less confidence and ability in managing critically ill patients and performing cardiopulmonary resuscitations during the 24-hour on-call shifts than during the NF shifts, p ˂ 0.050 each respectively.
The analysis of data regarding residents learning showed that residents perceived less acquisition of knowledge, less usage of new knowledge, less satisfaction with education and learning through simulation during their 24-hour on- call system compared to the NF systems, p ˂ 0.050 respectively. Furthermore, the residents had perceived their 24-hour on-call system as significantly less helpful for reviewing cases with peers, less permitting to in depth discussion of clinical skills with other peers and allowed less feedback from attending seniors when compared to their experiences during the NF episodes, p ˂ 0.050 each respectively.
The residents had perceived that the 24-hour on-call system is significantly more interruptive to ambulatory care rotations, more associated with post on-call call-backs and fatigue during weekends which affected their successive weekdays work rotations compared to their NF system, p ˂ 0.001 each respectively.
The overall rating of the different domains:
The analysis findings of the overall concepts with experiences of the two on-call systems showed that, the NF system had perceived significantly more positive impact on general wellness, more role resilient, healthier for residents’ social and family relationships. On top of that, less exposure to harm and risk, less impact on the quality of care they had delivered to their patients while working, less disruptions during the post NF system. Also, it showed more resilient with regards to emotional integrity of their patients care in comparison to the traditional 24-hour on-call system.
Furthermore, they perceived more work efficiency, higher teaching ability, higher skillfulness, better learning, and more efficient supervision during the NF on-calls. Means and standard deviations are shown in Table 3.
Figure 1. The senior residents’ mean perceptions of the two on-call systems