Systematic Review: Effects of Resident Work Hours on Patient Safety

Fletcher, Kathlyn E.; Davis, Steven Q.; Underwood, Willie; Mangrulkar, Rajesh S.; McMahon, Laurence F.; Saint, Sanjay

doi:10.7326/0003-4819-141-11-200412070-00009

Cited by 201 publications

(148 citation statements)

References 29 publications

Supporting

Mentioning

134

Contrasting

Unclassified

Order By: Relevance

“…This allows conclusions to be drawn that were not possible when the last comprehensive reviews on this subject were published. 8,9 Limitations notwithstanding, this review provides a comprehensive synthesis of the evidence base for the 2003 duty hour reforms in the US. The balance of evidence suggests that burnout among residents has decreased.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

2011

Self Cite

View full text Add to dashboard Cite

), 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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…We updated the Embase search in June 2010. We used an extensive search strategy in Medline, based on prior work 8,9 and consultation with a reference librarian. We conducted a similar search in Embase.…”

Section: Data Sourcesmentioning

confidence: 99%

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

2011

Self Cite

View full text Add to dashboard Cite

show abstract

“…We hypothesized that the 2003 Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements for Resident Duty Hours reform ("reform") would provide this opportunity because reform increased handoff s between providers [26][27][28] and spurred hospitals to make operational changes potentially impacting readmission rates. Changes included night-fl oat or other cross-coverage systems 29 and the addition of ancillary staff such as nurse practitioners and physician assistants to perform tasks formerly performed by residents. 30 …”

mentioning

confidence: 99%

Assessing the Utility of ICU Readmissions as a Quality Metric

Brown

Ratcliffe

Halpern

2015

Chest

View full text Add to dashboard Cite

BACKGROUND: ICU readmissions are associated with increased mortality and costs; however, it is unclear whether these outcomes are caused by readmissions or by residual confounding by illness severity. An assessment of temporal changes in ICU readmission in response to a specific policy change could help disentangle these possibilities. We sought to determine whether ICU readmission rates changed aft er 2003 Accreditation Council for Graduate Medical Education Resident Duty Hours reform ("reform") and whether there were temporally corresponding changes in other ICU outcomes.

show abstract

“…Diversas causas pueden explicarlo, pero en último término pueden reflejar la ausencia de este tipo de aproximación a los problemas clínicos diarios en las actividades de la UCI y, por tanto, constituir aspectos mejorables de estos servicios. A esto se puede sumar, por parte de los residentes, la disminución de horas en la cabecera del paciente [19] y un primer año sin responsabilidad objetiva [4], y por parte de las plantillas, una presión asistencial y administrativa que absorbe casi todo su tiempo. También cabe recalcar que muchos de los cursos que reciben sobre las dimensiones y actividades menos valoradas se basan en clases magistrales y, por tanto, con una baja capacidad de retenerse e influir en sus conductas y valoraciones.…”

Section: Como Profesional Aunclassified

Los residentes en las unidades de cuidados intensivos: ¿cuál es su percepción de la formación que reciben?

Vázquez-Mata¹,

Rodrı́guez-Elvira

Rucabado-Aguilar

et al. 2011

Educ. méd.

View full text Add to dashboard Cite

IntroducciónLa formación de los médicos residentes en las Unidades de Cuidados Intensivos (UCI) persigue prepararlos para una buena práctica clínica basada en el trabajo en equipo multidisciplinar; así mismo promueve la investigación, enseña a trabajar dentro de las dimensiones del profesionalismo, entrena en una buena comunicación en cualquier circunstancia y enseña a gestionar con calidad los recursos que dependan de ellos [1,2]. Paralelamente, la necesidad del reciclaje permanente para adaptarse a escenarios cambiantes hace que el autoaprendizaje y el pensamiento crítico sean imprescindibles en su Los residentes en las unidades de cuidados intensivos, ¿cuál es su percepción de la formación que reciben?Guillermo Vázquez-Mata, Manuel Rodríguez-Elvira, Luis Rucabado-Aguilar, Ángel García-Alcántara, Francisco Murillo-Cabezas, Pedro Navarrete-Navarro, Ana Guillamet-Lloveras, Juan Roca-Guiseris Objetivo. Este trabajo intenta responder a la pregunta de cuál es la visión que tienen los residentes de su formación en las unidades de cuidados intensivos (UCI). Sujetos y métodos.Hemos realizado un estudio cualitativo tipo grounded theory. Los participantes son residentes de cualquier especialidad que estuviesen trabajando en las UCI durante el estudio. El diseño tiene tres partes: percepción subjetiva de los residentes de aquellos aspectos que ellos consideran más útiles para su formación, priorización de las actividades regulares más características de las UCI y entrevistas semiestructuradas con informadores claves.Resultados. Nuestro trabajo identifica que los residentes consideran como eje de su formación la práctica clínica a 'pie de cama' desarrollada con autonomía y apoyada en una buena tutorización. Paralelamente, otras competencias nucleares como la investigación, la comunicación en situaciones complejas, el trabajo en equipo o la gestión de recursos están infravaloradas, mientras que otras como la seguridad del paciente o la bioética no se han detectado en las respuestas de los residentes.Conclusión. La percepción de los residentes sobre formación durante su estancia en las UCI adolece de algunas carencias, dado que ciertos aspectos claves de la medicina actual no se percibien como prioridades en dicha formación. Subjects and methods. We have conducted a qualitative study based on grounded theory. Participants are residents from different specialties working in the ICU of four hospitals of our National Health Service. The study consist of three parts: resident's subjective perception of those aspects most appreciate in their clinical practice; resident's prioritizations of routine ICU's activities, and semi-structured interviews with key informants.Results. According to the resident's opinions, the clinical practice at the beside of patients, and carried out with autonomy and with a good tutoring support are central to their training; nevertheless some central competencies such as research, difficult communication, team work or resource management are undervalued, while others such as patient safety or bioethic...

show abstract

Systematic Review: Effects of Resident Work Hours on Patient Safety

Abstract: Evidence on patient safety is insufficient to inform the process of reducing resident work hours.

Cited by 201 publications

References 29 publications

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

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

Assessing the Utility of ICU Readmissions as a Quality Metric

Los residentes en las unidades de cuidados intensivos: ¿cuál es su percepción de la formación que reciben?

Contact Info

Product

Resources

About