Impact of an internal medicine nocturnist service on care of patients with cancer at a large Canadian teaching hospital: a quality-improvement study

Richard Dunbar-Yaffe; Robert C. Wu; Amit Oza; Victoria Lee-Kim; Peter Cram

doi:10.9778/cmajo.20200167

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Table 1:

Characteristics and outcomes of patients admitted to the oncology team by residents versus nocturnists

Characteristic	No. (%) of patients^*		p value
Characteristic	Admitted by residents n = 133	Admitted by nocturnists n = 339	p value
Age, mean ± SD, yr	61.7 ± 14.5	60.4 ± 14.7	0.4
Female sex	58 (43.6)	159 (46.9)	0.5
Weekend admission	30 (22.6)	94 (27.7)	0.2
Charlson Comorbidity Index score, mean ± SD	4.6 ± 3.0	4.4 ± 3.1	0.6
In-hospital death	14 (10.5)	19 (5.6)	0.06
Readmitted	11 (8.3)	20 (5.9)	0.4
Acute length of stay, mean ± SD, d	7.2 ± 7.0	6.4 ± 7.8	0.3
Documented code status	47 (35.3)	186 (54.9)	< 0.001

Note: SD = standard deviation.
↵* Except where noted otherwise.

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Table 2:

Faculty survey responses

Question	No. (%) of respondents^* n = 15
Any experience with Toronto General Hospital general internal medicine–oncology Overnight Hospitalist program in clinical experience at Toronto General Hospital	15 (100)
Satisfaction with overall quality of care delivered at Toronto General Hospital, mean Likert score^† ± SD	3.6 ± 1.7
Since development of the Overnight Hospitalist program, the quality of care delivered at Toronto General Hospital general internal medicine has:
Improved	11 (73)
Stayed the same	2 (13)
Decreased	2 (13)
The Overnight Hospitalist program has decreased medical errors, mean Likert score^‡ ± SD	3.6 ± 1.2
The Overnight Hospitalist program leads to faster overnight evaluation of patients who are already admitted on the wards, mean Likert score^‡ ± SD	4.6 ± 0.9
The Overnight Hospitalist program leads to faster evaluation of new patients in the emergency department, mean Likert score^‡ ± SD	4.5 ± 0.9
The educational experience on the internal medicine CTU has improved as a result of the Overnight Hospitalist program, mean Likert score^‡ ± SD	4.1 ± 1.3
Effect of the Overnight Hospitalist program on your medical billings
No change	7 (47)
Decrease	2 (13)
Not sure	6 (40)
The Overnight Hospitalist program makes the hospital more attractive to residents, mean Likert score^‡ ± SD	4.0 ± 1.7
The Overnight Hospitalist program has reduced trainee burnout, mean Likert score^‡ ± SD	4.1 ± 1.0
The Overnight Hospitalist program has reduced faculty/attending physician burnout, mean Likert score^‡ ± SD	3.5 ± 1.0
The Overnight Hospitalist program improves my satisfaction while attending at Toronto General Hospital, mean Likert score^‡ ± SD	4.1 ± 1.1
Benefits of the Overnight Hospitalist program^§
Trainees have no need to obtain handover from or cross-cover teams overnight	12 (80)
Trainees do not need to hand over in the morning to more than 1 team	11 (73)
Trainees do not need to admit to more than 1 team overnight	9 (60)
Trainees have fewer patients to evaluate and admit from the emergency department overnight	12 (80)
Trainees do not need to manage transfers from other hospitals to the ward overnight	6 (40)
Trainees have fewer distractions from their admitting and call duties when working overnight	11 (73)
There is a dedicated physician in house to cover general internal medicine–oncology patients (Team 10)	13 (87)
There is a dedicated physician in house to admit general internal medicine–oncology patients (Team 10)	14 (93)
The physician covering general internal medicine–oncology patients (Team 10) and admitting new patients to Team 10 is more experienced	12 (80)
There is a greater likelihood that the trainee will be able to rest/sleep overnight	4 (27)
There is a greater likelihood that I will be able to rest/sleep overnight	6 (40)
There is a reduced need for trainees to communicate with the attending physician overnight	6 (40)
The nurses have improved access to physicians overnight regarding urgent patient issues	8 (53)
None of the above	1 (7)