Sleep Deprivation in Resident Physicians, Work Hour Limitations, and Related Outcomes: A Systematic Review of the Literature

Mansukhani, Meghna P.; Kolla, Bhanu Prakash; Surani, Salim; Varon, Joseph; Ramar, Kannan

doi:10.3810/pgm.2012.07.2583

Cited by 196 publications

(104 citation statements)

References 66 publications

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“…However, fatigue is still prevalent despite the restrictions. This is in agreement with other specialties, in which a recent systematic review demonstrated only a modest improvement in sleep and less fatigue [23]. Moreover, orthopaedic residents may be offsetting their activities into other academic pursuits [28].…”

Section: Discussionsupporting

confidence: 75%

What Effects Have Resident Work-hour Changes Had on Education, Quality of Life, and Safety? A Systematic Review

Harris

Staheli

LeClere

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background More than 15 years ago, the Institute of Medicine (IOM) identified medical error as a problem worthy of greater attention; in the wake of the IOM report, numerous changes were made to regulations to limit residents' duty hours. However, the effect of resident work-hour changes remains controversial within the field of orthopaedics. Questions/purposes We performed a systematic review to determine whether work-hour restrictions have measurably influenced quality-of-life measures, operative and technical skill development, resident surgical education, patient care outcomes (including mortality, morbidity, adverse events, sentinel events, complications), and surgeon and resident attitudes (such as perceived effect on learning and training experiences, personal benefit, direct clinical experience, clinical preparedness). Methods We performed a systematic review of PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were any English language peer-reviewed articles that analyzed the effect(s) of orthopaedic surgery resident work-hour restrictions on patient safety, resident education, resident/surgeon quality of life, resident technical operative skill development, and resident surgeon attitudes toward work-hour restrictions. Eleven studies met study inclusion criteria. One study was a prospective analysis, whereas 10 studies were of level IV evidence (review of surgical case logs) or survey results. Results Within our identified studies, there was some support for improved resident quality of life, improved resident sleep and less fatigue, a perceived negative impact on surgical operative and technical skill, and conflicting evidence on the topic of resident education, patient outcomes, and variable attitudes toward the work-hour changes. Conclusions There is a paucity of high-level or clear evidence evaluating the effect of the changes to resident work hours. Future research in this area should focus on objective measures that include patient safety as a primary outcome.

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Section: Discussionsupporting

confidence: 75%

What Effects Have Resident Work-hour Changes Had on Education, Quality of Life, and Safety? A Systematic Review

Harris

Staheli

LeClere

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Several other reports have noted the high work-related stress in the medical profession [14,15]. Many of these reports are from the USA, where the work hours are much longer than in our sample [47].…”

Section: Discussionmentioning

confidence: 64%

“…The following work-related factors are considered as putative risk factors for hazardous drinking among doctors: (1) work-related stress and work load (working long hours, sleep deprivation) [13,14,15] and (2) psychosocial factors at work (perceived job demands, autonomy) [16]. In addition, we assume that stress outside of work (life events) may be important [17].…”

Section: Introductionmentioning

confidence: 99%

Contextual Factors and Mental Distress as Possible Predictors of Hazardous Drinking in Norwegian Medical Doctors: A 15-Year Longitudinal, Nationwide Study

Mahmood

Grotmol²,

Tesli³

et al. 2016

Eur Addict Res

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Background: We have previously identified long-term individual predictors of hazardous drinking in doctors, but longitudinal studies on contextual factors (work and life stress) and mental distress being independently linked to hazardous drinking over the first 15 years of a medical career are lacking. Methods: Two nationwide cohorts of Norwegian doctors (n = 1,052) from all 4 Norwegian universities were surveyed in their final year of medical school (1993/1994 and 1999) (T1), and 4 (T2), 10 (T3), and 15 (T4) years later. Hazardous drinking was measured using a validated 9-item version of the Alcohol Use Disorder Identification Test. Work-related and other predictors were analysed using generalized estimating equations. Results: Ninety percent (947/1,052) responded at least once, and 42% (450/1,052) responded at all 4 time points. Hazardous drinking was reported by 16% at T1, 14% at T2 and T3, and 15% at T4. Life events (p = 0.009) and mental distress (p = 0.002) were adjusted predictors of hazardous drinking, in addition to male gender, no religious activity, drinking to cope with tension, and low conscientiousness. Conclusions: Doctors' work-related stress was not linked to hazardous drinking, but life events, mental distress, and drinking to cope were. Prevention should target mental distress and drinking to cope with tension.

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“…[2][3][4] Conversely, proponents of duty hour limits believe eliminating physician fatigue could minimize medical errors. [5][6][7] Studies have suggested that resident physicians are prone to committing errors, and exhibit diminished surgical skills when postcall. 8,9 Postcall orthopaedic surgery residents have been found to function at a level of impairment comparable with a blood alcohol concentration of 0.08%.…”

Section: Introductionmentioning

confidence: 99%

Effects of Fatigue on Driving Safety: A Comparison of Brake Reaction Times in Night Float and Postcall Physicians in Training

Talusan¹,

Long²,

Halim³

et al. 2014

Journal of Graduate Medical Education

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Background Concerns about duty hour and resident safety have fostered discussion about postshift fatigue and driving impairment. Objective We assessed how converting to a night float schedule for overnight coverage affected driving safety for trainees. Methods Brake reaction times were measured for internal medicine and orthopaedic surgery resident volunteers after a traditional 28-hour call shift and after a night float shift. We conducted matched paired t tests of preshift and postshift reaction time means. Participants also completed the Epworth Sleepiness Scale pre- and postshift. Results From June to July 2013, we enrolled 58 interns and residents (28 orthopaedic surgery, 30 internal medicine). We included 24 (41%) trainees on night float rotations and 34 (59%) trainees on traditional 28-hour call shifts. For all residents on night float rotations, there was no significant difference pre- and postshift. An increase in reaction times was noted among trainees on 28-hour call rotations. This included no effect on reaction times for internal medicine trainees pre- and postshift, and an increase in reaction times for orthopaedic trainees. For both night float and traditional call groups, there were significant increases in the Epworth Sleepiness Scale. Conclusions Trainees on traditional 28-hour call rotations had significantly worse postshift brake reaction times, whereas trainees on night float rotations had no difference. Orthopaedic trainees had significant differences in brake reaction times after a traditional call shift.

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Sleep Deprivation in Resident Physicians, Work Hour Limitations, and Related Outcomes: A Systematic Review of the Literature

Cited by 196 publications

References 66 publications

What Effects Have Resident Work-hour Changes Had on Education, Quality of Life, and Safety? A Systematic Review

What Effects Have Resident Work-hour Changes Had on Education, Quality of Life, and Safety? A Systematic Review

Contextual Factors and Mental Distress as Possible Predictors of Hazardous Drinking in Norwegian Medical Doctors: A 15-Year Longitudinal, Nationwide Study

Effects of Fatigue on Driving Safety: A Comparison of Brake Reaction Times in Night Float and Postcall Physicians in Training

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