spotlight on night float:

Spotlight on Night Float: Improving Orientation, Policies & Procedures

of the UC Irvine Night Float RotationWilliam Graham, Julie Lyou, Zo Noor, Matt Glassy,

Heather Hofmann, Katherine Yu

Faculty Mentor: Cliff Fornwalt, MD

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Background: What is Night Float?

UC Irvine| September 9, 2014

- A nocturnal rotation where residents:- Admit new patients from the ED and outside hospital transfers- Evaluate and manage urgent overnight medicine consults - Oversee care for all admitted medicine patients- Function essentially unsupervised

- Every resident in their 2nd and 3rd year does two night float rotations per year (4 total during residency).

- Unique experience, unlike daytime ward rotation (cross-cover, team H, working with house supervisor/SPPO, etc)

- In the past, material for night float has been in several places and much is passed on by word of mouth

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FOCUS Statement

Find an opportunity for improvement:

- UCI Ward night float rotation currently lacks a comprehensive orientation and information source for residents

- Many residents have expressed concern that they do not know how to address night-float specific issues


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FOCUS Statement

Organize Resources:

- Personnel: - Residents, Chiefs, Dr. Swaroop, Norma Hardgrove, Susan Altmayer, Dr.

Fornwalt

- Polices: locate all polices relating to UCI night float rotation

- Materials: locate and collect all other pertinent information


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FOCUS Statement

Clarify current knowledge:

- Current sources of information/policies:- Night float binder- Medicine Website- Medicine Sharepoint- Second-hand information from other residents

- Baseline measurements obtained through:- Online survey – created by us- New Innovations survey – created by the resident program

- New Innovations is used to survey the residents after each rotation - Gathers information about the resident experience so the program

can implement changes where needed- Mandatory to complete by every resident


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FOCUS Statement

Understand variation:

- Night float is a broad topic

- Procedures/policies for every possible scenario encountered may not exist

- Current polices and procedures already in place may be outdated or no longer applicable - i.e. The policy on orthopedic admissions to internal medicine was

written a decade ago


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FOCUS Statement

Select changes to be made:

- Meet with mentor and compile current orientation materials, the binder, policies, and procedures

- Survey senior residents with online survey


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Opportunity Statement

An opportunity exists to:

- Provide a comprehensive resource orientation- This is important because residents are essentially working

independently when on nightfloat- We need all information in one place for pt care/safety- We will know we are successful when our survey result

scores improve


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PDCA

- Plan: describe plan in detail

- Do: steps to implement plan

- Check: what happened with outcome measures

- Act: analyze outcomes and discuss revisions to enhance


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Data Collection

Plan & Do:

• Create a comprehensive night float manual

• Survey the residents to obtain baseline information

• Attend start of each night float rotation and go through orientation manual

• Survey residents again after intervention (change orientation)


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Data Collection – Plan & Do continued

Plan & Do:

• Create a survey questionnaire for night float residents• Baseline survey prior to orientation process• Use same questionnaire after intervention (change orientation)• Compare survey results

• Obtain New Innovations evaluation data • Obtain data prior to and after intervention• Compare survey results


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DATA – New Innovations

New Innovations

- Survey method already in place- Used to survey the residents after each rotation- Gathers information about the resident experience- Mandatory to complete by every resident- Available data goes back to 7/13

- Scale:- 1 = strongly disagree- 2 = somewhat disagree- 3 = neutral- 4 = somewhat agree- 5 = strongly agree


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DATA – New Innovations

New Innovations retrospective data ratings

- Responsibilities clearly defined (pre vs post)- 3.79 vs 4.26

- Learning objective clearly defined (pre vs post)- 3.81 vs 4.33

- Learning material and resources provided (pre vs post)- 3.22 vs 4.00

- Overall experience (pre vs post)- 3.95 vs 4.14


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Data – New Innovations


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DATA – Online survey

Online survey- Survey Monkey emailed to all residentsParticipants: - 30 residents completed pre-manual survey- 13 residents completed post-manual survey- All had completed a night float rotation or completed a

weekend of night call at UCIMCScale:

- 1 = strongly disagree- 2 = somewhat disagree- 3 = neutral- 4 = somewhat agree- 5 = strongly agree


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DATA – Online Survey Questions

Online Survey retrospective data ratings1. The logistics and policies specific to night float were adequately

reviewed prior to my work on night float. (pre vs post)- 2.2 vs 2.69

2. I know where to find the policies specific to night float, if questions arose in the middle of the night. (pre vs post)- 1.93 vs 2.85

3. Overall, I felt I had adequate resources to effectively perform my duties while on call at night and/or on UCI night float. (pre vs post)- 2.97 vs 3.46

4. While working at night, did you feel at any point you were providing substandard or unsafe care? (pre vs post)- 2.73 vs 1.31

5. If yes, do you feel a lack of familiarity with resources or policies contributed to this? (pre vs post)- 2.47 vs 2.14


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DATA – Online Survey


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DATA – Online Survey


The new Night Float Manual was helpful in completing my UCI night float duties.

• Strongly agree 7.69%

• Agree 30.77%

• Neutral 53.85%

• Disagree 7.59 %

• Strongly disagree 0%

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Data – Analysis

New Innovations Data

- Responsibilities, learning objectives and learning material & resources provided scores all improved to > 4.

Survey Data

- Resources adequately reviewed, policies locatable, and adequate resources available scores all improved.

- Feelings of providing substandard care and this due to lack of uncertainty scores declined.


20 UC Irvine| September 9, 2014

Where to Go From Here

- Continued improvement- What Qs arose during night float that were not answered in manual

- We would like to include a section in New Innovations for residents to address this Q

- Need a method to provide long term sustainability for a night float orientation

- Chiefs updating manual once per year

- Application of findings to orientation of other rotations

Thank you!

Drs. Cliff Fornwalt, Bindu Swaroop & Lloyd Rucker

Team 4: William Graham, Julie Lyou, Zo Noor, Matt Glassy,Heather Hofmann & Katherine Yu

spotlight on night float:

Documents

night float rotations

uci ward night float

residentuc irvine

online surveyuc irvine

specific issues uc irvine

residentsmany residents

decade agouc irvine

nocturnal rotation