Systematic Review: Effects of Resident Work Hours on Patient Safety

Systematic Review: Effects of Resident Work Hours on Patient Safety

From Ann Arbor Veterans Affairs Medical Center and the University of Michigan Medical School, Ann Arbor, Michigan, and University of Chicago Pritzker School of Medicine, Chicago, Illinois.

Abstract

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.

Article and Author Information

Acknowledgments: The authors thank Monica Lypson, MD, for her contribution to this project.
Grant Support: By the Ann Arbor Veterans Affairs Medical Center/University of Michigan's Patient Safety Enhancement Program. Dr. Fletcher was a Robert Wood Johnson Clinical Scholar and Veterans Affairs Scholar while most of this work was performed. Dr. Saint is supported by a Career Development Award from the Health Services Research & Development Program of the Department of Veterans Affairs and a Patient Safety Developmental Center Grant from the Agency for Healthcare Research and Quality (P20-HS11540).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Kathlyn E. Fletcher, MD, MA, Primary Care Division, Clement J. Zablocki Veterans Affairs Medical Center, 5000 West National Avenue, Milwaukee, WI 53295; e-mail, kathlyn.fletcher{at}med.va.gov.
Current Author Addresses: Dr. Fletcher: Primary Care Division, Clement J. Zablocki Veterans Affairs Medical Center, 5000 West National Avenue, Milwaukee, WI 53295.
Dr. Davis: 5841 South Maryland Avenue, MC 7082, Chicago, IL 60637.
Dr. Underwood: 6312 Medical Science Building 1, 1150 West Medical Center Drive, Ann Arbor, MI 48109-0604.
Dr. Mangrulkar: University of Michigan Medical School, 3116H TC, Campus Box 0368, Ann Arbor, MI 48109-0368.
Drs. McMahon and Saint: 300 North Ingalls Building, Room 7E08, Campus Box 0429, Ann Arbor, MI 48109-0429.