Balancing continuity of care with residents' limited work hours: defining the implications. Acad Med 2005 Jan;80(1):39-43
Date
12/25/2004Pubmed ID
15618090DOI
10.1097/00001888-200501000-00010Scopus ID
2-s2.0-11344270995 (requires institutional sign-in at Scopus site) 61 CitationsAbstract
The impact of the new resident work-hours rules on all aspects of patient care and education must be considered. While physician fatigue has taken center stage as the primary motivation behind this movement, the effect of these rules on the continuity of care for hospitalized patients needs to be critically analyzed from the perspectives of patients, physicians, and the health care system. The authors describe a conceptual framework that places continuity at the center and then considers the benefits and drawbacks of preserving continuity from the perspectives of the major stakeholders. They describe the categories of outcomes related to residents' fatigue and sleep deprivation that have been studied. Only a few studies have addressed patient outcomes, while most address resident outcomes. The authors discuss some of the possible solutions, including night float and the British system of shift work, and suggest that these solutions have different effects on each group of stakeholders, including both intended and unintended benefits and harms. Finally, the research agenda that arises from this framework is described. It includes taking into account multiple perspectives, identifying important outcomes, and considering unintended consequences. Using this framework, medical educators may better evaluate previous studies and consider remaining questions.
Author List
Fletcher KE, Saint S, Mangrulkar RSAuthor
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 CareFatigue
Health Services Research
Humans
Internship and Residency
Night Care
Personnel Staffing and Scheduling
Sleep Deprivation
Time Factors
Work Schedule Tolerance
Workload
