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Decision Support Tool Improves Real and Perceived Anesthesiology Resident Relief Equity

Bhutiani, Monica, MD, MEd*; Jablonski, Patrick M., PhD; Ehrenfeld, Jesse M., MD, MPH*; McEvoy, Matthew D., MD*; Fowler, Leslie C., MEd*; Wanderer, Jonathan P., MD, MPhil*,†

doi: 10.1213/ANE.0000000000003479
Medical Education: Original Clinical Research Report

BACKGROUND: The Accreditation Council of Graduate Medical Education requires monitoring of resident clinical and educational hours but does not require tracking daily work patterns or duty hour equity. Lack of such monitoring may allow for inequity that affects resident morale. No defined system for resident relief of weekday operating room (OR) clinical duties existed at our institution, leaving on-call residents to independently decide daily relief order. We developed an automated decision support tool (DST) to improve equitable decision making for clinical relief and assessed its impact on real and perceived relief equity.

METHODS: The DST sent a daily e-mail to the senior resident responsible for relief decisions. It contained a prioritized relief list of noncall residents who worked in the OR beyond 5 PM the prior clinical day. We assessed actual relief equity using the number of times a resident worked in the OR past 5:30 PM on 2 consecutive weekdays as our outcome, adjusting for the mean number of open ORs each day between 5:00 PM and 6:59 PM in our main OR areas. We analyzed 14 months of data before implementation and 16 months of data after implementation. We assessed perceived relief equity before and after implementation using a questionnaire.

RESULTS: After implementing the DST, the percentage of residents held 2 consecutive weekdays over the total of resident days worked decreased from 1.33% to 0.43%. The percentage of residents held beyond 5:30 PM on any given day decreased from 18.09% to 12.64%. Segmented regression analysis indicated that implementation of the DST was associated with a reduction in biweekly time series of residents kept late 2 days in a row, independent of the mean number of ORs in use. Surveyed residents reported the DST aided their ability to make equitable relief decisions (pre 60% versus post 94%; P = .0003). Eighty-five percent of residents strongly agreed that a prioritized relief list based on prior day work hours after 5 PM aided their decision making. After implementation, residents reported fewer instances of working past 5 PM within the past month (P < .005).

CONCLUSIONS: A DST systematizing the relief process for anesthesiology residents was associated with a lower frequency of residents working beyond 5:30 PM in the OR on 2 consecutive days. The DST improved the perceived ability to make equitable relief decisions by on-call senior residents and residents being relieved. Success with this tool allows for broader applications in resident education, enabling enhanced monitoring of resident experiences and support for OR assignment decisions.

From the *Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee

Vanderbilt Anesthesiology and Perioperative Informatics Research Division, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.

Published ahead of print June 5, 2018.

Accepted for publication April 3, 2018.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Monica Bhutiani, MD, MEd, Vanderbilt University Hospital, 2301 Garland Ave (Light Hall), Nashville, TN 37232-7237. Address e-mail to

© 2018 International Anesthesia Research Society
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