Implementing a Night Float System in Interventional Radiology: Impacts on Resident Wellness and Clinical Workflow

Evaluate the impact of an Interventional Radiology night float system on resident well-being and clinical service provided ‘off-hours’ as evidenced through survey data and clinical care documentation.

Materials and Methods:

This retrospective, IRB-exempt study spanned 12 months. Between January 1^st and June 30^th 2023 (the “before” period), resident call was covered per-day, taking home pager call in the evening.  Between July 1st and December 31^st 2023 (the “after” period), a night float was started with one resident taking a week-long rotation, with no daytime duties. The electronic medical record was reviewed for notes created by the residents between 5 PM and 7 AM and compared before and after the night-float system.

Surveys with questions focused on workflow, patient care, sleep, and wellness, comparing the old call system to night-float, were distributed to residents, advanced practitioners, and interventional radiology attendings¹. Data were analyzed and reported using descriptive statistics. The chi-square test was used to compare the number of notes between the two periods, with p < 0.05 considered significant.

Results:

502 patient notes were collected from 9 residents. The total number of notes increased significantly (Before = 127, after night float = 375, p-value = 0.03). There was more than a 200% increase in “Full patient consult notes” (303 vs. 91), while the number of “short communication notes” doubled (72 vs. 36).

17 IR trainees who worked in the “before period” responded, with 88.2% preferring the night-float system. Regarding wellness, 64.7% felt negatively affected, and 35.3% reported neutral feelings, with 100% reporting that their sleep schedules were negatively impacted in the prior system.

Eight senior IR trainees who participated in “night float” responded, and all reported better overall wellness and sleep (25% were affected positively, and 12.5% were neutral) compared to the old system. 6 IR Advanced Practice Providers (APPs) and 9 attending physicians indicated that night float positively affected their general wellness (66.7% of APPs and 77.8% of attendings) and reported a perception of improved patient care (100% agreement).

Conclusion:

A night-float system increased the overall well-being and productivity of IR residents, according to survey data and documented patient consults. Night-float coverage should be studied to measure improvement in trainee morale, timeliness of patient care, reduction in daytime consult workload, and potential for increasing revenue through consultation billing and emergency department bed turnover.