Effects of the Accreditation Council for Graduate Medical Education Duty Hour Limits on Sleep, Work Hours, and Safety

Landrigan, Christopher P.; Fahrenkopf, Amy M; Lewin, Daniel; Sharek, Paul J.; Barger, Laura K.; Eisner, Melanie; Edwards, Sarah; Chiang, Vincent W.; Wiedermann, Bernhard L.; Sectish, Theodore C.

doi:10.1542/peds.2007-2306

Cited by 171 publications

(133 citation statements)

References 36 publications

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“…[16][17][18] This study present results, that night shift worker physicians have poor sleep quality and it is not different among their specialty's or seniority's in work. This result is new than in literature.…”

Section: Discussionmentioning

confidence: 47%

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Assessment of the Pittsburgh Sleep Quality Index among Physician's Speciality Who Work Night Shifts

Tür¹,

Toker²,

Tür³

et al. 2015

Emerg Med Open J

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Objective: As with other people, sleep quality has an impact on a physician's work safety. Aim of this study is determine the sleep quality among medical specialists whose working night shifts, and detect other independent factors that affect their sleep quality. This is essential for improving the physician health and their daily performance for patient care. Methods: A qualitative study was design with a cross-sectional method. Sampling was conducted with stratification among night shift physicians who work in the emergency, internal medicine and surgical departments at an education and research hospital. Scores on the Pittsburgh Sleep Quality Index (PSQI) and the Swedish Demand-Control-Support Questionnaire (DCSQ) were assessed. Results: One hundred eight physicians who worked night shifts responded to the questionnaire. The average age of the physicians was 31.3±5.9, and 40.7% were women. The average PSQI score in male participants was significantly higher (8.1±3.7 vs. female 7.6±3.9; p=0.014). The majority of physicians (83.3%) had high PSQI values, i.e., scores of 5 or more. No significant difference was found in the average PSQI values between the emergency and internal medicine physicians and surgeons (p>0.05). The most important factors that affected physicians' sleep quality were the number of night shifts per month, age, gender and the existence of a chronic disease. Conclusion: The sleep quality of medical specialists who work night shifts is equally low. The existence of a chronic disease, age, gender and higher numbers of night shifts affect sleep quality as powerful independent factors.

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Section: Discussionmentioning

confidence: 47%

“…[16][17][18] Suggestion is physicians won't be pass 80 hours in a week and 16-30 hours at once a shift. Thus, sleep withdrawal, medical mistakes and accidents can be avoided.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Pittsburgh Sleep Quality Index among Physician's Speciality Who Work Night Shifts

Tür¹,

Toker²,

Tür³

et al. 2015

Emerg Med Open J

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“…94 However, other aspects of well-being such as rates of depression do not seem to have changed between the pre-2003 period and the post-2003 period. 21,22,36,95 Prior research has demonstrated links between resident well-being and quality of patient care, 96,97 making preservation of resident well-being extremely important. This improvement in well-being may be one explanation for why some patient care parameters are improving in the post-2003 time period.…”

Section: Discussionmentioning

confidence: 99%

“…A study in pediatric residents failed to show improvement in medication errors after changes to reduce duty hours were implemented. 80 The other study showed that intercepted medication errors made by internal medicine residents were decreased after duty hour rules were initiated. 26 …”

Section: Errorsmentioning

confidence: 98%

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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“…Among the greatest concerns to most were the relative absence of objective data regarding the effects, both positive and negative, of the current duty hour requirements and the potential educational and economic impacts of the proposed changes. [4][5][6][7][8] …”

mentioning

confidence: 99%

The Response of the APPD, CoPS and AAP to the Institute of Medicine Report on Resident Duty Hours

Guralnick

Rushton

Bale³

et al. 2010

Pediatrics

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In December 2008, the Institute of Medicine published new recommendations regarding duty hours and supervision of residents' training in the United States. These recommendations evoked immediate concerns from program directors and leadership in all surgical and medical disciplines, including pediatrics. To address these concerns, the Accreditation Council for Graduate Medical Education convened a Duty Hours Congress in Chicago, Illinois, on June 11 and 12, 2009. This report summarizes the opinions and testimony of the organizations (American Academy of Pediatrics, Association of Pediatric Program Directors, and Council of Pediatric Specialties) that were invited to represent pediatrics at the Duty Hours Congress. The American Academy of Pediatrics, the Association of Pediatric Program Directors, and the Council of Pediatric Specialties supported the basic principles of the Institute of Medicine report regarding patient safety, resident supervision, resident safety, and the importance of effective “hand-offs”; however, the organizations opposed additional reductions in resident duty hours given the potential unintended adverse effects on the competency of trainees, the costs of graduate medical education, and the future pediatric workforce. These organizations agreed that additional changes in graduate medical education must be data driven and consider residents within the broader system of health care. The costs and benefits must be carefully analyzed before implementing the Institute of Medicine recommendations.

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Effects of the Accreditation Council for Graduate Medical Education Duty Hour Limits on Sleep, Work Hours, and Safety

Abstract: Total hours of work and sleep did not change after implementation of the duty hour standards. Although fewer residents were burned out, rates of medication errors, resident depression, and resident injuries and educational ratings did not improve.

Cited by 171 publications

References 36 publications

Assessment of the Pittsburgh Sleep Quality Index among Physician's Speciality Who Work Night Shifts

Assessment of the Pittsburgh Sleep Quality Index among Physician's Speciality Who Work Night Shifts

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

The Response of the APPD, CoPS and AAP to the Institute of Medicine Report on Resident Duty Hours

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