1. Effect on Patient Safety of a Resident Physician Schedule without 24-Hour Shifts
- Author
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Landrigan, Christopher P, Rahman, Shadab A, Sullivan, Jason P, Vittinghoff, Eric, Barger, Laura K, Sanderson, Amy L, Wright, Kenneth P, O'Brien, Conor S, Qadri, Salim, St Hilaire, Melissa A, Halbower, Ann C, Segar, Jeffrey L, McGuire, John K, Vitiello, Michael V, de la Iglesia, Horacio O, Poynter, Sue E, Yu, Pearl L, Zee, Phyllis C, Lockley, Steven W, Stone, Katie L, and Czeisler, Charles A
- Subjects
Clinical Trials and Supportive Activities ,Patient Safety ,Clinical Research ,Prevention ,Cross-Over Studies ,Humans ,Intensive Care Units ,Pediatric ,Internship and Residency ,Medical Errors ,Personnel Staffing and Scheduling ,Psychomotor Performance ,Sleep ,Time Factors ,Work Schedule Tolerance ,Workload ,ROSTERS Study Group ,Medical and Health Sciences ,General & Internal Medicine - Abstract
BackgroundThe effects on patient safety of eliminating extended-duration work shifts for resident physicians remain controversial.MethodsWe conducted a multicenter, cluster-randomized, crossover trial comparing two schedules for pediatric resident physicians during their intensive care unit (ICU) rotations: extended-duration work schedules that included shifts of 24 hours or more (control schedules) and schedules that eliminated extended shifts and cycled resident physicians through day and night shifts of 16 hours or less (intervention schedules). The primary outcome was serious medical errors made by resident physicians, assessed by intensive surveillance, including direct observation and chart review.ResultsThe characteristics of ICU patients during the two work schedules were similar, but resident physician workload, described as the mean (±SD) number of ICU patients per resident physician, was higher during the intervention schedules than during the control schedules (8.8±2.8 vs. 6.7±2.2). Resident physicians made more serious errors during the intervention schedules than during the control schedules (97.1 vs. 79.0 per 1000 patient-days; relative risk, 1.53; 95% confidence interval [CI], 1.37 to 1.72; P
- Published
- 2020