Duty-Hour Limits and Patient Care and Resident Outcomes: Can High-Quality Studies Offer Insight into Complex Relationships?

Abstract

Long hours are an accepted component of resident education, yet data suggest they contribute to fatigue that may compromise patient safety. A systematic review confirms that limiting duty hours increases residents' hours of sleep and improves objective measures of alertness. Most studies of operative experience for surgical residents found no effect, and there is evidence of a limited positive effect on residents' mood. We find a mixed effect on patient safety, although problems with supervision, rather than the limits, may be responsible or contibute; evidence of reduced continuity of care and reduced continuity in residents' clinical education; and evidence that increased workload under the limits has a negative effect on patient and resident outcomes. We highlight specific areas for research and offer recommendations for national policy.

Nursing Duty Hours’ Length and the Perceived Outcomes of Care

“…These are consistent with previous studies. Scholars have found that staff duty hour has a mixed effect on quality and safety of patient care (Estabrooks et al, 2009;Philibert et al, 2013;Stone et al, 2006). Some have found that working 8-hour shifts is negatively associated with the outcomes of care (Stone et al, 2006).…”

“…There is a lack of guide that can provide policy-makers the optimal duty length (Stone et al, 2006). Many studies have illustrated that nurse duty hours' length has a mixed effect on patient safety and quality outcomes (Estabrooks et al, 2009;Philibert, Nasca, Brigham, & Shapiro, 2013;Stone et al, 2006). For instance, some studies have found that limiting duty hours leads to decreased continuity of care and increased workload, which in turn negatively affect patient safety and staff performance (Philibert et al, 2013).…”

“…Many studies have illustrated that nurse duty hours' length has a mixed effect on patient safety and quality outcomes (Estabrooks et al, 2009;Philibert, Nasca, Brigham, & Shapiro, 2013;Stone et al, 2006). For instance, some studies have found that limiting duty hours leads to decreased continuity of care and increased workload, which in turn negatively affect patient safety and staff performance (Philibert et al, 2013). Others have found that nurses assigned for 12-hour shifts had higher job satisfaction and are less fatigued than nurses assigned for 8-hour shifts (Stone et al, 2006).…”

“…Others have found that nurses assigned for 12-hour shifts had higher job satisfaction and are less fatigued than nurses assigned for 8-hour shifts (Stone et al, 2006). On the other hand, limiting working hours reduces burnout and fatigue, and enhances staff mood and sleeping hours, which in turn lead to improved performance (Philibert et al, 2013). Similarly, Estabrooks et al (2009) found contradictory results regarding shift length and the quality of patient care.…”

Wake up call

“…A National Academy of Medicine report showed that sleep deprivation causes errors and that alertness and performance vary with the point in one's circadian rhythm [1]. However, there is no conclusive evidence that resident duty hours are associated with patient mortality or other clinical outcomes [2]. The FIRST Trial looking at 119 surgical residency programmes demonstrated non-inferiority of patient outcomes in surgical programmes using flexible duty hours [3].…”