F. G. Javier1, L. S. Lehmann4, M. J. Erlendson1, K. A. Davis2, M. R. Mercurio3, C. Thiessen2 1Yale University School Of Medicine,New Haven, CT, USA 2Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA 3Yale University School Of Medicine,Department Of Pediatrics,New Haven, CT, USA 4Brigham And Women’s Hospital,Department Of Medicine,Boston, MA, USA
Introduction: Electronic medical records (EMRs) have emerged as residents face increasing duty hour restrictions. EMRs allow residents to perform patient care work at home. Our study investigated this work-shifting phenomenon.
Methods: We conducted semi-structured interviews of general surgery residents. We randomly selected one intern and one chief resident at each of 13 participating US programs and invited them to complete a 20-30 minute telephone interview. We asked about EMR access; frequency and magnitude of, type of, and reasons for work at home; and whether residents included work at home in their recorded duty hours. Interviews were recorded, transcribed, and coded using an iterative major and minor coding process in Dedoose.
Results: Fourteen surgery residents from 11 US programs completed interviews (8 interns, 6 chiefs, 6 women, 8 men). All participants had remote access to their institution’s EMR and all reported working at home at least occasionally. The majority (12/14) reported working at home for approximately 5 hours per week (range 15 minutes-20 hours). They checked patient’s labs and results (14/14), prepared for cases (11/14), and reviewed charts before new rotations (11/14). Most residents (11/14) expressed the “need to get out of the hospital…take a break and just finish things later on in the evening.” Half preferred the comfort of home: “It’s just more relaxed. If it’s at the end of the day and there’s some paperwork, I’d rather not do it at the hospital, I’d rather do it in my pajamas in my bed.” Working at home “because they can’t get the full job done at the hospital” or to finish work that “gets pushed off things like dictations…patient notes” was a common theme (7/14). Review of labs and results was often prompted by a sense of responsibility for patient care or “out of a personal curiosity that that patient had not done well during the day and I was wondering how they were going to do at night.” Many residents invoked work at home as training for becoming an attending. Working at home was “just part of being a physician”: “as an attending, you’re always on pager call…you need to be aware of what’s going on and checking in on your patients.” This perception was reinforced by “hav[ing] seen our attendings do it” and the fact that they “ended up getting quite a few home calls” because “attendings don’t always know when we’re in the hospital or not.” No participant recorded work at home in their duty hours. Most felt that “it’s not in-hospital work.” Many stated that their work at home was too little or too much to count.
Conclusion: Our results indicate that general surgery residents often work at home to follow-up on patients or complete required documentation, without counting this time as duty hours. Working at home is primarily driven by professionalism and preference. The extent of working at home is not yet fully recognized; institutional and ACGME policies responsive to work-shifting should be developed.