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

2 Background: What is Night Float? UC Irvine| September 9, 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 2 nd and 3 rd 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

3 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 UC Irvine| September 9, 2014

4 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 UC Irvine| September 9, 2014

5 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 -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

6 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for every possible scenario encountered may not exist -Current polices and procedures already in place may be outdated or no longer applicable - i.e. The policy on orthopedic admissions to internal medicine was written a decade ago UC Irvine| September 9, 2014

7 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 UC Irvine| September 9, 2014

8 Opportunity Statement An opportunity exists to: -Provide a comprehensive resource orientation - This is important because residents are essentially working 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

9 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 UC Irvine| September 9, 2014

10 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) UC Irvine| September 9, 2014

11 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 UC Irvine| September 9, 2014

12 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 UC Irvine| September 9, 2014

13 DATA – New Innovations New Innovations retrospective data ratings -Responsibilities clearly defined (pre vs post) vs Learning objective clearly defined (pre vs post) vs Learning material and resources provided (pre vs post) vs Overall experience (pre vs post) vs 4.14 UC Irvine| September 9, 2014

14 Data – New Innovations UC Irvine| September 9, 2014

15 DATA – Online survey Online survey -Survey Monkey ed 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 UC Irvine| September 9, 2014

16 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) vs I know where to find the policies specific to night float, if questions arose in the middle of the night. (pre vs post) vs 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) vs While working at night, did you feel at any point you were providing substandard or unsafe care? (pre vs post) vs If yes, do you feel a lack of familiarity with resources or policies contributed to this? (pre vs post) vs 2.14 UC Irvine| September 9, 2014

17 DATA – Online Survey UC Irvine| September 9, 2014

18 DATA – Online Survey UC Irvine| September 9, 2014 The new Night Float Manual was helpful in completing my UCI night float duties. Strongly agree7.69% Agree30.77% Neutral53.85% Disagree7.59 % Strongly disagree0%

19 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. UC Irvine| September 9, 2014

20 UC Irvine| September 9, 2014 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

Thank you! Drs. Cliff Fornwalt, Bindu Swaroop & Lloyd Rucker Team 4: William Graham, Julie Lyou, Zo Noor, Matt Glassy, Heather Hofmann & Katherine Yu