Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units

Landrigan, Christopher P.; Rothschild, Jeffrey M.; Cronin, John; Kaushal, Rainu; Burdick, Elisabeth; Katz, Joel T.; Lilly, Craig M.; Stone, Peter H.; Lockley, Steven W.; Bates, David W.; Czeisler, Charles A.

doi:10.1056/nejmoa041406

Cited by 1,525 publications

(1,001 citation statements)

References 41 publications

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“…Several studies have been conducted to determine the relationship between work and sleep hours and rates of medical errors among physicians. These studies have concluded that elimination of extended shifts decreased attentional failures during night duty [3,7]. …”

Section: Introductionmentioning

confidence: 99%

Night duty and decreased brain activity of medical residents: a wearable optical topography study

Nishida

Kikuchi

Miwakeichi

et al. 2017

Medical Education Online

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Background: Overwork, fatigue, and sleep deprivation due to night duty are likely to be detrimental to the performance of medical residents and can consequently affect patient safety. Objective: The aim of this study was to determine the possibility of deterioration of cerebral function of sleep-deprived, fatigued residents using neuroimaging techniques. Design: Six medical residents were instructed to draw blood from artificial vessels installed on the arm of a normal cooperator. Blood was drawn at a similar time of the day, before and after night duty. To assess sleep conditions during night duty, the participants wore actigraphy units throughout the period of night duty. Changes in cerebral hemodynamics, during the course of drawing blood, were measured using a wearable optical topography system. Results: The visual analogue scale scores after night duty correlated negatively with sleep efficiency during the night duty (ρ = −0.812, p = 0.050). The right prefrontal cortex activity was significantly decreased in the second trial after night duty compared with the first (p = 0.028). The extent of [oxy-Hb] decrease, indicating decreased activity, in the right dorsolateral prefrontal cortex correlated negatively with the Epworth sleepiness score after night duty (ρ = −0.841, p = 0.036). Conclusions: Sleep deprivation and fatigue after night duty, caused a decrease in the activity of the right dorsolateral prefrontal cortex of the residents, even with a relatively easy routine. This result implies that the brain activity of medical residents exposed to stress on night duty, although not substantially sleep-deprived, was impaired after the night duty, even though they apparently performed a simple medical technique appropriately. Reconsideration of the shift assignments of medical residents is strongly advised. Abbreviations: DLPFC: Dorsolateral prefrontal cortex; ESS: Epworth sleepiness scale; PSQI: Pittsburgh sleep quality index; ROI: Regions of interest; VAS: Visual analogue scale; WOT: Wearable optical topography

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Section: Introductionmentioning

confidence: 99%

Night duty and decreased brain activity of medical residents: a wearable optical topography study

Nishida

Kikuchi

Miwakeichi

et al. 2017

Medical Education Online

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“…Even after these modifications, concerns remained about how compliant residents were with the duty hour rules, 2 and one rigorous study suggested that further reductions in maximum shift length could lead to safer patient care. 3 The Institute of Medicine (IOM) conducted an investigation in 2008 and published recommendations for further reductions in resident duty hours. 4 Partially in response to the IOM report, the ACGME convened a duty hours task force to examine the issues and propose revisions in the duty hour standards.…”

Section: Introductionmentioning

confidence: 99%

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

2011

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), bibliographies, pertinent reviews, and meeting abstracts. STUDY SELECTION: We included studies examining the relationship between the pre-and post-2003 time periods and patient outcomes (mortality, complications, errors), resident education (standardized test scores, clinical experience), and well-being (as measured by the Maslach Burnout Inventory). We excluded non-US studies. DATA EXTRACTION: One rater used structured data collection forms to abstract data on study design, quality, and outcomes. We synthesized the literature qualitatively and included a meta-analysis of patient mortality. RESULTS: Of 5,345 studies identified, 60 met eligibility criteria. Twenty-eight studies included an objective outcome related to patients; 10 assessed standardized resident examination scores; 26 assessed resident operative experience. Eight assessed resident burnout. Metaanalysis of the mortality studies revealed a significant improvement in mortality in the post-2003 time period with a pooled odds ratio (OR) of 0.9 (95% CI: 0.84, 0.95). These results were significant for medical (OR 0.91; 95% CI: 0.85, 0.98) and surgical patients (OR 0.86; 95% CI: 0.75, 0.97). However, significant heterogeneity was present (I 2 83%). Patient complications were more nuanced. Some increased in frequency; others decreased. Outcomes for resident operative experience and standardized knowledge tests varied substantially across studies. Resident well-being improved in most studies. LIMITATIONS: Most studies were observational. Not all studies of mortality provided enough information to be included in the meta-analysis. We used unadjusted odds ratios in the meta-analysis; statistical heterogeneity was substantial. Publication bias is possible. CONCLUSIONS:Since 2003, patient mortality appears to have improved, although this could be due to secular trends. Resident well-being appears improved. Change in resident educational experience is less clear.

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“…On the one hand, sleep deprivation impairs residents' clinical performance. Shorter shifts have been associated with fewer medical errors in five out of five studies 8,44,45 . On the other hand, patient handovers generally increase as duty-hours decline and the risk of PAEs is five-fold higher when interns are cross-covering 46 .…”

Section: Discussionmentioning

confidence: 89%

Cost Implications of ACGME’s 2011 Changes to Resident Duty Hours and the Training Environment

Nuckols

Escarce

2011

J GEN INTERN MED

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Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units

Cited by 1,525 publications

References 41 publications

Night duty and decreased brain activity of medical residents: a wearable optical topography study

Night duty and decreased brain activity of medical residents: a wearable optical topography study

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

Cost Implications of ACGME’s 2011 Changes to Resident Duty Hours and the Training Environment

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