Condition category
Not Applicable
Date applied
19/04/2018
Date assigned
24/04/2018
Last edited
24/04/2018
Prospective/Retrospective
Prospectively registered
Overall trial status
Ongoing
Recruitment status
Recruiting

Plain English Summary

Background and study aims
Due to an increasing number of patients with multiple or complex illnesses, a heavier administrative burden, and the evolution of young residents’ expectations, organization of work in internal medicine wards is of utmost importance. In a 2015 study, we showed that residents spent 1.5 hours on administrative tasks and 1.7 hours with patients per day. In addition, residents switched activity on average 15 times per hour. This study investigated major reforms: task delegation to non-medical professionals, reorganization of the workday’s schedule, and implementation of an early morning inter-professional decision meeting. An associated reduction in administrative and working hours and increased time with patients could greatly improve job satisfaction and attractiveness for internal medicine. We aim to quantify the impact of the organizational and structural reforms implemented in our department between 2016 and 2017 on residents’ administrative workload, continuity and adequacy of work, duration of shifts, and time spent with patients.

Who can participate?
Resident physicians at an internal medicine ward at Lausanne University Hospital.

What does the study involve?
The residents will be observed for two 11-hour shifts. The 'before reform' group was observed in 2015 and results are already published. The 'after reform' group will be observed in 2018, using the same methods and tools. The intervention is made of major reforms implemented between 2016 and 2017, which will be reported in detail. The primary outcome will be time spent for administrative tasks. We will also measure the amount of task switching per hour, the mismatch between observed activities compared to the departmental work schedule, the effective duration of observed shifts, and the time spent in presence of patients. We added a qualitative part by means of focus groups composed of observed residents.

What are the possible benefits and risks of participating?
There are no additional risks or benefits from participating in the study, because the physicians will be working as normal.

Where is the study run from?
Lausanne University Hospital

When is the study starting and how long is it expected to run for?
May 2018, with recruitment for 3 weeks.

Who is funding the study?
An external funding application has been submitted.

Who is the main contact?
Dr Antoine Garnier, antoine.garnier@chuv.ch

Trial website

Contact information

Type

Scientific

Primary contact

Dr Antoine Garnier

ORCID ID

Contact details

CHUV
Rue du Bugnon 46
Lausanne
1011
Switzerland

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

N/A

Study information

Scientific title

Impact of structural and organizational reforms on residents’ daily work

Acronym

MED2DAY

Study hypothesis

Because of an increasing number of complex polymorbid patients, a heavier administrative burden, and the evolution of young resident physicians’ expectations, organization of work in internal medicine wards is of utmost importance. In a 2015 study, we showed that residents spent 1.5 hours on administrative tasks and 1.7 hours with patients per day. In addition, residents switched activity on average 15 times per hour. This study motivated major reforms: task delegation to non-medical professionals, reorganization of the workday’s schedule, and implementation of an early morning inter-professional decision meeting. An associated reduction in administrative and working hours and increased time with patients could greatly improve job satisfaction and attractiveness for internal medicine.

Ethics approval

The local ethical committee confirmed that this study is not subject to ethical approval.

Study design

Observational cross-sectional study

Primary study design

Observational

Secondary study design

Cross sectional study

Trial setting

Hospitals

Trial type

Other

Patient information sheet

No participant information sheet available.

Condition

Organization of healthcare and and physicians' work in a hospital setting.

Intervention

Organizational and structural reforms, including task delegation to non-medical professionals, reorganization of the workday’s schedule, and implementation of an early morning interprofessional decision meeting, implemented in our department between 2016 and 2017. We expect to include 35 residents. Each resident being observed twice (meaning 2 shifts of approx. 11 hours per resident), we will gather between 700 and 900 hours of observation.

Intervention type

Other

Phase

Drug names

Primary outcome measures

Time spent for administrative tasks (primary outcome), assessed by time-motion study with observation of residents’ activities during shifts, by observers using a dedicated tablet application

Secondary outcome measures

1. Amount of task switching per hour
2. Mismatch between observed activities compared to the departmental work schedule
3. Effective duration of observed shifts
4. Time spent in presence of a patient

Overall trial start date

01/01/2018

Overall trial end date

31/12/2018

Reason abandoned

Eligibility

Participant inclusion criteria

1. All residents registered in the internal medicine department at CHUV during the study, having graduated from a medical school, and with informed consent

Participant type

Health professional

Age group

Adult

Gender

Both

Target number of participants

35

Participant exclusion criteria

Inclusion criteria not met

Recruitment start date

01/05/2018

Recruitment end date

21/05/2018

Locations

Countries of recruitment

Switzerland

Trial participating centre

Lausanne university hospital
1011
Switzerland

Sponsor information

Organisation

Department of medicine

Sponsor details

CHUV
Rue du Bugnon 46
Lausanne
1011
Switzerland

Sponsor type

Hospital/treatment centre

Website

www.chuv.ch

Funders

Funder type

Not defined

Funder name

Investigator intiated. Funding pending.

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Results and Publications

Publication and dissemination plan

Planned publication in a high-impact peer reviewed journal.

IPD sharing statement
The data sharing plans for the current study are unknown and will be made available at a later date.

Intention to publish date

01/06/2019

Participant level data

To be made available at a later date

Results - basic reporting

Publication summary

Publication citations

Additional files

Editorial Notes