Rideshare/Taxi Service

WHAT?

The goal of this intervention is to:

• Reimburse residents for rides to and from the hospital.

WHY?

Organizational Culture and Values

Reimbursing residents for travel when fatigued demonstrates the department/institution recognizes residents work hard and cares about their safety.

Workload & Job Demands

Due to the oftentimes long and odd hours worked by residents, fatigue is of high concern. There is an increased risk of motor vehicle collision due to “drowsy driving,” particularly in post-call residents. Over a six month period, 34.7% of general surgery residents reported nodding off while driving after call, with 26.6% reporting a near-miss MVC and 5.0% an MVC.[1] This intervention provides options for reimbursing transportation to and from the hospital when a resident is too fatigued to safely drive.

How?

Step 1. Assess program needs

1.Survey residents to estimate needs and costs. Possible mechanisms for administration include Google Forms, RedCap, Qualtrics, and Survey Monkey. You may adapt/use our survey:

1. Thinking back on the last 6 months, how many times did you experience the following:
   1. Motor vehicle accident after being on call
   2. Near-miss motor vehicle incident (in which property damage or body harm was narrowly avoided) after being on call
   3. Nodded off or fallen asleep while driving or stopped in traffic after being on call
2. I currently drive to these rotations: [list all rotations].
   1. Branching logic (i.e., this question needs to be asked for each checked rotation): I live [ ] miles away from [rotation site].)
3. I would use a rideshare service on these services (check all that apply): [list all rotations].
   1. Branching logic (i.e., this question needs to be asked for each checked rotation): I would likely use it: [every time I am post-call, most of the time I am post-call, half the time I am post-call, rarely]

2.Work with the individual(s) who make the call schedule(s) (e.g., coordinators, chief residents, administrative chief residents) to ascertain the number of calls per resident at each site.

3.Rideshare apps often price rides according to demand as well as distance traveled, such that it is more expensive to travel during certain times of days (or during inclement weather). For a higher rate of accuracy, you can put in sample rides (e.g., from X hospital to Y address) at the approximate times of day (e.g., post-call at X hospital is usually at 9 am) to get price estimates.

4.Consider that a resident may need a ride both ways, i.e., back to the hospital to get their car after they’ve rideshared home post-call.

5.With this data, you should be able to roughly estimate costs.

Step 2. Secure funding

1. Consider involving the following in your discussion:

• Departmental leadership and/or finance
• GME
• Hospital administration
• Risk management

2.Make the point that “drowsy driving” is a safety issue. [1] A single debilitating accident likely costs more than the amount you will spend in rideshare reimbursement. You may also cite SECOND Trial data which demonstrates that 80% of programs provide travel reimbursement. [2]

3.Determine whether you need to set a per-resident, per-year limit on travel reimbursements. Alternatively, you could limit usage to specific rotations.

Step 3.Create a mechanism for reimbursement

Options include:

1.Individual residents pay up front and submit receipts for reimbursement.

• Identify an individual who will be responsible for coordination of reimbursement.In many programs, this is the program coordinator.

Publish a policy outlining appropriate uses of the program and the process for reimbursement. You may adapt/use our fillable policy. Examples for Northwestern, UCLA, and UT Houston are provided.

• Advertise the policy to residents to ensure they are aware of its existence. Make it easily accessible to them (e.g., central website, shared drive). Periodically remind residents (e.g., annually during orientation).

2.Set up an organizational rideshare account. This option saves administrative time for your residents as well as the person who coordinates their reimbursements.

1. Uber
   1. Uber for Business: Residents order their own rides and expense/charge them to a central account. You can set spending limits, times, and vehicle types.
      1. For example, the University of Alabama has an Uber for Business account. When requesting a ride, residents can toggle between the Business account and their personal account
   2. Uber Central: A designated person(s) orders all of the rides. Users don’t need the Uber app, since they aren’t the ones that coordinate the ride.
   3. Uber Vouchers : Allows customizable terms (e.g., how much of the ride to cover, where the ride can go).
2. Lyft
   1. Lyft Business: Users expense/charge rides to a central account. You can require that notes are entered before rides.
   2. Lyft Concierge: A designated person(s) orders all of the rides. Users don’t need the Lyft app, since they aren’t the ones that coordinate the ride.
   3. Lyft Credits: Give monthly credits. You may set limits on price, time, location, and vehicle type.

Helpful Resources

Coaches/Successful Implementations

Cleveland Clinic

Coach: Jeremy Lipman, MD Program Director

UCLA

Coach: Timothy Donahue, MD Program Director

References

1. Schlick CJR, Hewitt DB, Quinn CM, et al. A national survey of motor vehicle crashes among general surgery residents. Ann Surg (in Press).

2. SECOND Trial Program Director Survey. Internal Report: Unpublished.