scholarly journals Resident Duty Hours: A Review

1970 ◽  
Vol 9 (4) ◽  
Author(s):  
Lindsay Melvin ◽  
Sophie Corriveau ◽  
Aiman Alak ◽  
Ameen Patel
Keyword(s):  
Patient Safety ◽  
Resident Education ◽  
Well Being ◽  
The United States ◽  
Complex Issue ◽  
Duty Hours ◽  
Fatigue Management ◽  
Controversial Topic ◽  
Resident Duty ◽  
Work Up

Residents are physicians undertaking further training to become independently licensed practitioners. Historically, resident duty hour periods were long and intense. The goal was to maximize learning through high patient volume and to teach doctors how to take responsibility. Recently, concerns over patient and resident safety have led to restricted trainee work hours. The putative justification is to improve resident education, resident well-being, and patient care. In light of this recent shift in the medical culture, resident duty hours have become a controversial topic. Restricted duty hours take many forms. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) mandated junior residents work no longer than 16 consecutive hours, while senior residents could work up to 26 hours.1 In Canada, no nationwide mandate exists and the issue falls within provincial jurisdiction. In Ontario, under the Professional Association of Residents of Ontario agreement, call-periods are no more than 26 consecutive hours in-house, no more than one in four nights in-house, or no more than one in three nights of home-call. After a 2011 Quebec court ruling, resident duty hours were restricted to 16 consecutive hours in that province. This resulted from the court concluding that traditional hours violate the Canadian Charter of Rights and Freedoms. Regardless, the Quebec ruling prompted other Canadian programs to further reduce resident duty hours and consecutive hours on-call. To better understand this complex issue, the following review discusses resident safety, resident performance, resident education, and patient safety. Our goal is to present a balanced, evidence-based discussion, addressing both patient safety and resident fatigue management.

scholarly journals Tides of change

2014 ◽  
Vol 82 (2) ◽  
pp. 4-5
Author(s):  
Jouseph Barkho
Keyword(s):  
United States ◽  
Patient Safety ◽  
Task Force ◽  
The United States ◽  
Medical Resident ◽  
Negative Effects ◽  
Duty Hours ◽  
The Past ◽  
Work Hour ◽  
Resident Duty

The paradigm of medical resident duty hours is currently undergoing vast changes, as research has demonstrated the negative effects of sleep deprivation on the wellbeing of both patients and residents alike. These changes began in the United States, where reduced work hour schedules for residents have been implemented within the past decade. However, the effectiveness of these changes has been debated in the literature. In Canada, this issue has only recently come into spotlight. Under the guidance of the Royal College of Physicians and Surgeons of Canada, a task force was assembled in 2012 with two main objectives: gather all evidence related to resident duty hours, fatigue, and patient safety, and to create a national Canadian consensus on resident duty hours.

scholarly journals A Narrative Review of Surgical Resident Duty Hour Limits: Where Do We Go From Here?

2013 ◽  
Vol 5 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Peter D. Fabricant ◽  
Christopher J. Dy ◽  
David M. Dare ◽  
Mathias P. Bostrom
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Resident Education ◽  
Historical Context ◽  
Performance Standards ◽  
Improve Patient Care ◽  
Surgical Resident ◽  
Duty Hours ◽  
Resident Duty ◽  
Improve Patient

Abstract Background Resident duty hour limits have been a point of debate among educators, administrators, and policymakers alike since the Libby Zion case in 1984. Advocates for duty hour limits in the surgical subspecialties cite improvements in patient safety, whereas opponents claim that limiting resident duty hours jeopardizes resident education and preparedness for independent surgical practice. Methods Using orthopaedic surgery as an example, we describe the historical context of the implementation of the duty hour standards, provide a review of the literature presenting data that both supports and refutes continued restrictions, and outline suggestions for policy going forward that prioritize patient safety while maintaining an enhanced environment for resident education. Results Although patient safety markers have improved in some studies since the implementation of duty hour limits, it is unclear whether this is due to changes in residency training or external factors. The literature is mixed regarding academic performance and trainee readiness during and after residency. Conclusion Although excessive duty hours and resident fatigue may have historically contributed to errors in the delivery of patient care, those are certainly not the only concerns. An overall “culture of safety,” which includes pinpointing systematic improvements, identifying potential sources of error, raising performance standards and safety expectations, and implementing multiple layers of protection against medical errors, can continue to augment safety barriers and improve patient care. This can be achieved within a more flexible educational environment that protects resident education and ensures optimal training for the next generation of physicians and surgeons.

scholarly journals Delinking resident duty hours from patient safety

2014 ◽  
Vol 14 (S1) ◽  
Author(s):  
Roisin Osborne ◽  
Christopher S Parshuram
Keyword(s):  
Patient Safety ◽  
Duty Hours ◽  
Resident Duty

Implementation of duty hour standards in otolaryngology-head and neck surgery residency training

2005 ◽  
Vol 132 (6) ◽  
pp. 819-822 ◽  
Author(s):  
Todd A. Kupferman ◽  
Tim S. Lian
Keyword(s):  
Head And Neck ◽  
Residency Training ◽  
Training Programs ◽  
Neck Surgery ◽  
Program Directors ◽  
The United States ◽  
Head And Neck Surgery ◽  
Training Experience ◽  
Duty Hours ◽  
Resident Duty

OBJECTIVE: To determine what impact, if any, of the recently implemented duty hour standards have had on otolaryngology-head and neck surgery residency programs from the perspective of program directors. We hypothesized that the implementation of resident duty hour limitations have caused changes in otolaryngology training programs in the United States. STUDY DESIGN AND SETTING: Information was collected via survey in a prospective, blinded fashion from program directors of otolaryngology-head and neck residency training programs in the United States. RESULTS: Overall, limitation of resident duty hours is not an improvement in otolaryngology-head and neck residency training according to 77% of the respondents. The limitations on duty hours have caused changes in the resident work schedules in 71% of the programs responding. Approximately half of the residents have a favorable impression of the work hour changes. Thirty-two percent of the respondents indicate that changes to otolaryngology support staff were required, and of those many hired physician assistants. Eighty-four percent of the respondents did not believe that the limitations on resident duty hours improved patient care, and 81% believed that it has negatively impacted resident training experience. Forty-five percent of the program directors felt that otolaryngology-head and neck faculty were forced to increase their work loads to accommodate the decrease in the time that residents were allowed to be involved in clinical activities. Fifty-four percent of the programs changed from in-hospital to home call to accommodate the duty hour restrictions. CONCLUSIONS: According to the majority of otolaryngology-head and neck surgery program directors who responded to the survey, the limitations on resident duty hours imposed by the ACGME are not an improvement in residency training, do not improve patient care, and have decreased the training experience of residents. SIGNIFICANCE: This study demonstrates that multiple changes have been made to otolaryngology-head and neck surgery training programs because of work hour limitations set forth by the ACGME.

scholarly journals Development of the individualised Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial: a protocol summary of a national cluster-randomised trial of resident duty hour policies in internal medicine

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021711 ◽  
Author(s):  
Judy A Shea ◽  
Jeffrey H Silber ◽  
Sanjay V Desai ◽  
David F Dinges ◽  
Lisa M Bellini ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Patient Safety ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Medicare Beneficiaries ◽  
Internal Medicine Training ◽  
Duty Hours ◽  
Time Motion ◽  
Wrist Actigraphy ◽  
Resident Duty

IntroductionMedical trainees’ duty hours have received attention globally; restrictions in Europe, New Zealand and some Canadian provinces are much lower than the 80 hours per week enforced in USA. In USA, resident duty hours have been implemented without evidence simultaneously reflecting competing concerns about patient safety and physician education. The objective is to prospectively evaluate the implications of alternative resident duty hour rules for patient safety, trainee education and intern sleep and alertness.Methods and analysis63 US internal medicine training programmes were randomly assigned 1:1 to the 2011 Accreditation Council for Graduate Medical Education resident duty hour rules or to rules more flexible in intern shift length and number of hours off between shifts for academic year 2015–2016. The primary outcome is calculated for each programme as the difference in 30-day mortality rate among Medicare beneficiaries with any of several prespecified principal diagnoses in the intervention year minus 30-day mortality in the preintervention year among Medicare beneficiaries with any of several prespecified principal diagnoses. Additional safety outcomes include readmission rates, prolonged length of stay and costs. Measures derived from trainees’ and faculty responses to surveys and from time-motion studies of interns compare the educational experiences of residents. Measures derived from wrist actigraphy, subjective ratings and psychomotor vigilance testing compare the sleep and alertness of interns. Differences between duty hour groups in outcomes will be assessed by intention-to-treat analyses.Ethics and disseminationThe University of Pennsylvania Institutional Review Board (IRB) approved the protocol and served as the IRB of record for 40 programmes that agreed to sign an Institutional Affiliation Agreement. Twenty-three programmes opted for a local review process.Trial registration numberNCT02274818; Pre-results.

scholarly journals Complying with ACGME Resident Duty Hours Restrictions: Restructuring the 80-Hour Workweek to Enhance Education and Patient Safety at Texas A&M/Scott & White Memorial Hospital

2006 ◽  
Vol 81 (12) ◽  
pp. 1026-1031 ◽  
Author(s):  
Paul E. Ogden ◽  
Stephen Sibbitt ◽  
Martha Howell ◽  
David Rice ◽  
Jeana O???Brien ◽  
...  
Keyword(s):  
Patient Safety ◽  
Memorial Hospital ◽  
Duty Hours ◽  
Resident Duty

scholarly journals Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial

2015 ◽  
Vol 187 (5) ◽  
pp. 321-329 ◽  
Author(s):  
Christopher S. Parshuram ◽  
Andre C.K.B. Amaral ◽  
Niall D. Ferguson ◽  
G. Ross Baker ◽  
Edward E. Etchells ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Randomized Trial ◽  
Continuity Of Care ◽  
Well Being ◽  
Resident Duty

The effect of duty hour regulations on outcomes of neurological surgery in training hospitals in the United States: duty hour regulations and patient outcomes

2014 ◽  
Vol 121 (2) ◽  
pp. 247-261 ◽  
Author(s):  
Kiersten Norby ◽  
Farhan Siddiq ◽  
Malik M. Adil ◽  
Stephen J. Haines
Keyword(s):  
New York ◽  
Hospital Mortality ◽  
Sleep Deprivation ◽  
Patient Outcomes ◽  
The United States ◽  
Neurosurgical Procedures ◽  
Duty Hours ◽  
Discharge Disposition ◽  
Neurosurgical Patients ◽  
Resident Duty

Object The effects of sleep deprivation on performance have been well documented and have led to changes in duty hour regulation. New York State implemented stricter duty hours in 1989 after sleep deprivation among residents was thought to have contributed to a patient's death. The goal of this study was to determine if increased regulation of resident duty hours results in measurable changes in patient outcomes. Methods Using the Nationwide Inpatient Sample (NIS), patients undergoing neurosurgical procedures at hospitals with neurosurgery training programs were identified and screened for in-hospital complications, in-hospital procedures, discharge disposition, and in-hospital mortality. Comparisons in the above outcomes were made between New York hospitals and non–New York hospitals before and after the Accreditation Council for Graduate Medical Education (ACGME) regulations were put into effect in 2003. Results Analysis of discharge disposition demonstrated that 81.9% of patients in the New York group 2000–2002 were discharged to home compared with 84.1% in the non–New York group 2000–2002 (p = 0.6, adjusted multivariate analysis). In-hospital mortality did not significantly differ (p = 0.7). After the regulations were implemented, there was a nonsignificant decrease in patients discharged to home in the non–New York group: 84.1% of patients in the 2000–2002 group compared with 81.5% in the 2004–2006 group (p = 0.6). In-hospital mortality did not significantly change (p = 0.9). In New York there was no significant change in patient outcomes with the implementation of the regulations; 81.9% of patients in the 2000–2002 group were discharged to home compared with 78.0% in the 2004–2006 group (p = 0.3). In-hospital mortality did not significantly change (p = 0.4). After the regulations were in place, analysis of discharge disposition demonstrated that 81.5% of patients in the non–New York group 2004–2006 were discharged to home compared with 78.0% in the New York group 2004–2006 (p = 0.01). In-hospital mortality was not significantly different (p = 0.3). Conclusions Regulation of resident duty hours has not resulted in significant changes in outcomes among neurosurgical patients.

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