Systematic review: effects of resident work hours on patient safety. Ann Intern Med 2004 Dec 07;141(11):851-7
Date
12/08/2004Pubmed ID
15583227DOI
10.7326/0003-4819-141-11-200412070-00009Scopus ID
2-s2.0-10044241721 (requires institutional sign-in at Scopus site) 183 CitationsAbstract
BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) mandated new work hours rules for all residency programs in July 2003.
PURPOSE: To critically evaluate the evidence that adhering to the ACGME standards will improve patient safety.
DATA SOURCES: Searches of electronic databases (MEDLINE, EMBASE, PREMEDLINE, and Current Contents) and other methods to identify the English-language literature for studies on resident work hours for the years 1966 to 2004.
STUDY SELECTION: Studies that assessed a system change designed to counteract the effects of work hours, fatigue, or sleep deprivation and that included an outcome related to patient safety were included. Seven studies met these criteria.
DATA EXTRACTION: Two investigators abstracted data from all included studies by using a standard data abstraction form; each study was rated according to established criteria to assess study design quality.
DATA SYNTHESIS: Interventions used were float systems, other cross-coverage systems, or unspecified schedule changes. Outcomes included mortality, adverse events, and medication errors. The results suggest that introducing such interventions has an unclear effect on selected patient safety indicators. Specifically, some indicators (such as mortality) may not change after interventions, while other indicators may improve or worsen.
LIMITATIONS: This analysis is limited by the study designs of the included studies, the diversity of interventions in the studies, and the possibility of publication bias favoring studies that demonstrated statistically significant differences.
CONCLUSION: Evidence on patient safety is insufficient to inform the process of reducing resident work hours.
Author List
Fletcher KE, Davis SQ, Underwood W, Mangrulkar RS, McMahon LF Jr, Saint SAuthor
Kathlyn E. Fletcher MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Continuity of Patient CareGuideline Adherence
Internship and Residency
Patient Care
Practice Guidelines as Topic
Research Design
Safety
United States
Work Schedule Tolerance