The Impacts of a Night Float Call System Within an Orthopaedic Residency Programme: A Prospective Analysis of Resident Wellness, Satisfaction, and Education

Our orthopedic program has historically utilized a 24-hour call system to cover the trauma service. The high number of post call days lead to significant disruption from clinical and academic duties. Additionally, resident wellness and quality of life is largely impacted by work hours and call burden. Some Canadian orthopedic programs have successfully implemented a night float alternative and reported improved resident quality of life and satisfaction. Other programs have made a similar switch and reported worse health-related quality of life. As of July 2023, our program transitioned from traditional 24-hour call to a night float system. The purpose of this study was to analyze the impacts of a night float on resident wellness, satisfaction, and education. This prospective study began data collection in May 2023. Orthopedic residents completed surveys at the end of every four week rotation. These surveys assessed health status (SF-36 scores), educational outcomes, and resident satisfaction. We compared the data of three different cohorts: traditional 24-hour call residents, the night float resident, and non-night float residents working within a night float system. The 24-hour resident data was collected during the last three blocks of the traditional system. Once the night float began, data collection each block included the night float resident and non-night float residents. Surveys were sent out every four weeks over 16 educational blocks until July 2024. A total of 92 submissions were collected across 16 academic blocks. Three study groups included orthopedic rotation resident (N=63), night float (N=11), and traditional 24-hour call resident (N=18). Across the three cohorts there were no significant differences in health-related outcomes which included individual SF-36 scores as well as physical and mental component scores (p-values >0.05). Orthopedic rotation residents strongly agreed (78.7%) and agreed (13.1%) that their educational experience was improved by having a night float system in place. Additionally, 77% strongly agreed and 14.8% agreed that their quality of life was improved by having a night float in place. Educational outcomes showed no significant differences in study time or teaching rounds attendance (p>0.05). Junior residents were previously taking approximately 55 post call days per year. With the night float system junior residents missed less than five days each due to post call requirements. This equated to a net benefit of over 50 working days for junior residents. Furthermore, junior residents are doing approximately 50 less 24-hour shifts over a full academic year with the new call system. A night float system is a reasonable alternative to the traditional 24-hour call system for an orthopedic program. The night float decreases post call days and 24-hour shifts at the expense of one high volume month of call. There were no significant differences in health-related outcomes and most residents were satisfied with the new call system. More data is required to further understand the impact on educational outcomes.