780 - Perceptions of in-house staff physician coverage on staff physicians, trainees and allied healthcare professionals: A mixed-methods study

Poster Number: 780
Publication Number: 780.248

Eman Hashim, The Hospital for Sick Children, Toronto, ON, Canada; Amanda C. Wyman, York University, Toronto, ON, Canada; Emer Finan, Mount Sinai Hospital, Toronto, ON, Canada; Karel O’Brien, Mount Sinai Hospital, Toronto, Toronto, ON, Canada; Rebecca Pillai Riddell, York University, Toronto, ON, Canada; Vibhuti Shah, Mount Sinai Hospital, Toronto, ON, Canada

Background: There has been an increasing focus on NICU staffing and 24/7 in-house staff physician coverage with the aim of improving neonatal outcomes. However, this model of care is not universally adapted.

Objective: To assess the impact of in-house staff coverage on staff physicians, trainees and allied healthcare professionals (AHPs).

Design/Methods: Surveys and semi-structured interviews were conducted with staff physicians, trainees and AHPs to assess perceptions of this model of care. Physicians’ survey explored their perceived contribution to clinical care and the impact of in-house coverage on team function, trainee education, and physician wellbeing. Surveys were completed using a 5 point Likert scale the day after their call. Trainees and AHPs were surveyed monthly using a 5 point Likert scale. Results are presented using descriptive statistics. Thematic analysis of interviews was conducted by 2 trained individuals (AW, RPR) using an inductive approach.

Results: 250 staff responses were analyzed. Staff reported that their presence contributed positively to clinical care and education (70%), negatively impacted trainees’ decision making (20%), their own decision making post-call (25%) and their physical (52%) and mental (47%) well-being. 10 trainees’ responses were analyzed. They were comfortable having staff in-house (60%) and reported that staff presence had a positive impact on delivery of care (40%). One third of respondents reported that opportunities for independent decision making were negatively impacted. 9 staff physicians were interviewed while 6 fellows participated in 2 focus groups and 1 individual interview. Main themes for staff were decreased job satisfaction (56%) with negative impact on physical (67%) and mental well-being (63%). Trainees had mixed opinions with some believing that having in-house staff interfered with decision making and progression of graduated responsibility while others reported less stress with staff being in-house.
Of the 148 AHPs responses analyzed, they reported that the presence of staff physicians had a positive impact and reduced their anxiety (86%), altered care (81%), impact on inter-professional team (65%) and affected work flow and functionality (76%). They felt that having staff coverage assisted in managing high acuity patients and they felt safer as they had access to individuals with higher level of experience and knowledge.

Conclusion(s): In-house staff coverage was associated with negative impact on staff physicians’ well-being while trainees had mixed opinions and AHPs reported positive impact.