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Spotlight on Night Float:
Improving Orientation, Policies & Procedures
of the UC Irvine Night Float Rotation
William Graham, Julie Lyou, Zo Noor, Matt Glassy,
Heather Hofmann, Katherine Yu
Faculty Mentor: Cliff Fornwalt, MD
Background: What is Night Float?
- 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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UC Irvine| September 9, 2014
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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UC Irvine| September 9, 2014
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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UC Irvine| September 9, 2014
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
-
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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
UC Irvine| September 9, 2014
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outdated or no longer applicable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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UC Irvine| September 9, 2014
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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UC Irvine| September 9, 2014
Opportunity Statement
An opportunity exists to:
- Provide a comprehensive resource orientation
- This is important because residents are essentially working
-
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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
UC Irvine| September 9, 2014
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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UC Irvine| September 9, 2014
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 residents
Participants:
- 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 UCIMC
Scale:
- 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 ratings
1. 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.
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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
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Thank you!
Drs. Cliff Fornwalt, Bindu Swaroop & Lloyd
Rucker
Team 4: William Graham, Julie Lyou, Zo Noor, Matt Glassy,
Heather Hofmann & Katherine Yu