Incentivizing internal medicine residents to take sick leave and its effect on inpatient transmission of influenza at an academic hospital

Medical residents are primary caregivers to patients in academic centers. Current sick pay policies for residents often do not provide compensation to residents who take off for sickness, and potentially encourage residents to work in times of illness. Incentivizing residents to take off of work during periods of illness might decrease acquisition of transmissible infections to patients for whom they provide care. We plan to perform a prospective, randomized trial of instituting a resident sick pay policy on incidence of inpatient influenza infections. We will randomly assign four housestaff run inpatient medicine services to current sick leave policy or a pilot program that pays a salary for time spent covering residents out sick. Patients admitted to these services will be tested on admission and then three times per week for influenza A and B. Those patients who are negative on admission, but subsequently test positive for influenza during hospital admission will be classified with a hospital acquired infection. We predict a baseline hospital acquired influenza infection incidence of 5% in our control group and an effect size of 60%, for a 2% incidence in the intervention group. The patient population will include all patients admitted to the oncology, cardiology, general medicine 1, general medicine 2 services. As each medical service admits approximately 200 patients per month, we will conduct the study for two-three months beginning in December 2009, to maximize enrollment of patients during the influenza season.