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Systematic review: effects of resident work hours on patient safety
Kathlyn E Fletcher1, Steven Q Davis, Willie Underwood
1Ann Arbor Veterans Affairs Medical Center and the University of Michigan Medical School, Ann Arbor, Michigan, USA. kathlyn.fletcher@med.va.gov
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.
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