Decreasing Resident Work Hours and Improved Patient Safety

Newswise — A systematic review of current studies that evaluated the impact of reducing resident work hours on patient safety found that decreasing resident fatigue by limiting the number of hours worked did not affect mortality rates. The study led by Kathlyn E. Fletcher, M.D., assistant professor of general internal medicine at the Medical College of Wisconsin, and clinician/researcher at the VA Medical Center, Milwaukee, found conflicting results from the many interventions that have been tried to reduce resident work hours. The researchers showed that while some interventions probably do result in safe care, others likely do not, and some may even result in harm. The study appears in the December 7, 2004, issue of the Annals of Internal Medicine.

Shortening resident hours has long been a goal of several medical organizations as well as the consumer watchdog group, Public Citizen. Dr. Fletcher points out that the widely accepted belief that limiting physician work hours and decreasing fatigue will improve patient safety led to mandated new work hour rules for all residency programs in July 2003. The effect of this universal change in resident work hours on patient safety is unknown, Dr. Fletcher says.

"The debate on reducing resident fatigue has to be balanced with any impact it may have on the loss of continuity of care," according to Dr. Fletcher. "The predictable consequence of decreasing hours of care is that multiple physicians must now care for an individual patient. The trade-off between the positive values of continuity of care and decreasing resident fatigue has important implications for patient safety. It is difficult to know how to achieve an optimal balance."

The researchers looked at studies on resident work hours from 1966 to March 2004 which mentioned the problem of sleep deprivation. The 1,372 citations were then narrowed down to 343 articles of which 42 studies described relevant interventions. Of these, seven intervention studies from 1990 to 2004 that assessed patient safety outcomes were selected for study. Some of the studies were of questionable quality as there was not sufficient information on patient sample, data collection and data analysis and none of them were randomized controlled trials.

Major findings of the study are:

* Mortality was not changed in any study* Patients were more likely to have a complication or a test delay after schedule changes occurred in one study* Potentially preventable adverse events were significantly associated with coverage by a non-primary team member in another study* Fewer medications errors were made after changes in another study

"Safe patient care is our profession's most important priority requiring that we continue to examine reform strategies to optimize positive patient outcomes," Dr. Fletcher states. "Additional well-funded, multi-institutional studies are needed to ensure that our current efforts improve patient care."

The study was funded by the Ann Arbor Veterans Affairs Medical Center and 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