Our institution has instituted ''short-call'' and ''nightfloat'' syste
ms to reduce the number of admissions to the traditional ''long-call''
housestaff. However, the nightfloat system introduces increased disco
ntinuity to patient care, and interns may spend less time with short-c
all patients because they are not required to spend the night on-call.
Discontinuity and less time spent with patients may result in decreas
ed patient satisfaction. Over a 6-month period, data were collected on
145 consecutive patients admitted to a teaching Veterans Affairs Medi
cal Center with the primary diagnoses of congestive heart failure and
chronic obstructive pulmonary disease. We found that patients admitted
to either short-call or nightfloat interns were significantly less sa
tisfied with their care than patients admitted to long-call housestaff
, controlling for intern gender, patient age, and patient severity of
illness (p = .02). Residency program directors need to realize that ch
anges in the structure of teaching environment may have an impact on p
atient satisfaction.