Resident duty hours and resident and patient outcomes: Systematic review and meta‐analysis

Abstract

Objectives The policies regarding resident physician work hours are constantly being evaluated and changed. However, the results of randomised control trials (RCTs) are mixed. This systematic review of RCTs aims to synthesise the evidence associated with resident duty hour restrictions and its impact on resident‐ and patient‐based outcomes. Methods A comprehensive search of the Cochrane Library, EMBASE and PubMed was conducted from inception until 31 July 2020. Any RCT evaluating the impact of longer resident physician work hours compared to shorter resident physician work hours on resident‐ and patient‐based outcomes was eligible for inclusion. Two reviewers extracted data independently. The primary outcome was the impact of resident duty hour restrictions on emotional exhaustion, depersonalisation and personal accomplishment, as defined by the Maslach Burnout Inventory. The secondary patient‐related outcomes were patient hospital length of stay, serious medical errors and preventable adverse events. Data were pooled using a random‐effects model. Results Of the 873 references, nine RCTs met the inclusion criteria. A shorter shift length compared with longer shift length was associated with significantly less emotional exhaustion (standardised mean difference [SMD] = −0.11, 95% CI = −0.21, −0.00) and less dissatisfaction with overall well‐being (OR = 0.61, 95% CI 0.38, 0.99) but not with hospital length of stay (SMD = −0.01, 95% CI = −0.05, 0.02, p = 0.45) and serious medical errors per 1000 patient hours (OR = 1.07, 95% CI = 0.52, 2.21; p = 0.86). Conclusions Shorter resident duty hours is possibly associated with improvement in resident‐based outcomes, specifically, emotional exhaustion, dissatisfaction with overall well‐being, sleep duration and sleepiness. These findings may inform the policy change in support of reduced shift hours resulting in overall well‐being for the residents with possible reduction in burnout without adverse impact on patient‐based outcomes.

Staff well‐being: Is it time to rethink implications for work schedules?

“…As previously mentioned, Sephien et al’s review did not find an association between shift length and adverse events or serious medical errors 2 . This is consistent with findings from an earlier review investigating medical practitioner burnout and patient outcomes 15 .…”

“…The Quadruple Aim builds on from Berwick and colleague's Triple aim for optimising health system performance, 5 adding a new dimension: improving the work life of health care practitioners 6,7 . Sephien et al’s systematic review indirectly talks to this aspect of providing quality care through raising the importance of caring for ourselves 2 …”

“…This can negatively impact staff morale and results in additional costs to the organisation in replacing staff and orientating new staff to the workplace. Recent studies have suggested that younger health care workers are at increased risk of burnout, 8,14 which would encompass the medical residents included in Sephien et al's review 2 . Policy makers would be well‐advised to review all policies and practices, including work schedules, that could potentially influence a health care professional's decision to stay or leave their chosen profession.…”

“…6,7 Sephien et al's systematic review indirectly talks to this aspect of providing quality care through raising the importance of caring for ourselves. 2 The importance of positive staff well-being is increasingly being recognised by health care organisations, educational institutions, accreditation bodies and professional associations.…”

“…1 However, how does this impact the health professional's, that is, the carer's own well‐being in such situations? Sephien and colleagues’ 2 systematic review investigating the evidence associated with resident doctor duty hour restrictions and its impact on resident and patient based outcomes is timely as we grapple with staff well‐being and workforce shortages, exacerbated by the COVID‐19 pandemic. The review identified that shorter shift lengths compared with longer shift lengths were associated with significantly less dissatisfaction with overall well‐being, less sleepiness and less emotional exhaustion.…”