REAL-TIME DUTY HOUR REPORTING FOR NEPHROLOGY FELLOWS THROUGH A

SMARTPHONE APP
William A. Dvila, MD, Hunter A. Coore, MD, Tejas Desai, MD
INTRODUCTION
Duty hour monitoring is an important but timeconsuming task for trainees to complete in a timely
manner. Despite a number of commercial software, our
trainees have had delays in reporting their hours by
weeks to months.
These delays prevent Program
Directors (PD) from identifying overworked trainees in
real-time. In this early investigation, we designed an
iOS App, based on the suggestions of our trainees, to
record duty hours and measured the time delay in
reporting those hours. We report a near real-time duty
hour monitoring system using an iOS App. The limited
reporting delay has allowed the PD to anticipate dutyhour violations and take proactive measures to manage
over-worked trainees.

MATERIALS & METHODS

We programmed the Nephrology On-Demand Plus iOS
App to collect duty hour information. Each entry asked
the fellow their:
1) Name
2) Unique hospital employee number
3) Time and day in and out
4) Rotation name.
The App automatically added a time-stamp to each
entry. We compared the time difference between the
time-out and time-stamp to calculate the delay in
reporting.

RESULTS
A total of 534 duty hour entries were recorded from 7/1/14 - 2/09/15
Duty Hours were recorded for 3 inpatient rotations and 0 outpatient rotations. The
inpatient rotations consist of:
1) Service*
2) Consults**
3) ICU***
There are 5 fellows in total, 2 1st year fellows and 3 2nd year fellows.
1st year fellows recorded 263 duty hours logs.
2nd year fellows recorded 271 duty hour logs.
There was no statistically significant difference between 1st year and 2nd year
fellow log numbers.
There was a median time delay for all logs of 1.11 hours (IQR: 0.210-3.85 hours),
maximum of 89.88 hours. (Figure1)
1st year fellows has a median delay of 0.758 hours (IQR: 0.178-4.261 hours.)
2nd year fellows had a median delay of 1.263 hours (IQR: 0.266-3.434 hours.)
Using Wilcoxon Test, there was no statistical difference between the two
groups (p=0.1915.)
The difference between rotations showed that the Consult fellow had a median
delay of 1.085 hours (IQR: 0.2483-4.164 hours), ICU Fellow median delay was
0.925 hours (IQR: 0.204-3.808 hours), and Service fellow median delay was 1.250
hours (IQR: 0.163-2.462 hours.) (Figure 2)
Using a Wilcoxon Test for each pair showed no statistical significance.
Fellow schedules have been modified four times based on the above data.
The PD sent 13 reminders to the fellows to make sure duty hours were logged

Figure 1

*=A total of 20 patients in which the fellow acts a the primary provider.
**=Anywhere between 20-30 consults from all medical and surgical services except for those in the
intensive care units
***=Anywhere between 2-10 consults from all medical and surgical intensive care units

CONCLUSION

http://goo.gl/tfSAQT
NKF Spring Clinical Meeting 2015, Dallas TX

The real-time duty hour monitoring system has allowed the PD to anticipate dutyhour violations and take proactive measures to manage over worked trainees. This
is a simple and convenient way for our trainees to report their duty hours.

Figure 2

William A. Dvila, MD
Hunter A. Coore, MD
Division of Nephrology and Hypertension
East Carolina University
Greenville, North Carolina 27858
252.744.2545
cooreh@ecu.edu
davilaw14@ecu.edu