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Effect of reducing interns' work hours on serious medical errors in intensive care units.

Authors
Landrigan-CP; Rothschild-JM; Cronin-JW; Kaushal-R; Burdick-E; Katz-JT; Lilly-CM; Stone-PH; Lockley-SW; Bates-DW; Czeisler-CA
Source
N Engl J Med 2004 Oct; 351(18):1838-1848
NIOSHTIC No.
20025826
Abstract
Background: Although sleep deprivation has been shown to impair neurobehavioral performance, few studies have measured its effects on medical errors. Methods: We conducted a prospective, randomized study comparing the rates of serious medical errors made by interns while they were working according to a traditional schedule with extended (24 hours or more) work shifts every other shift (an "every third night" call schedule) and while they were working according to an intervention schedule that eliminated extended work shifts and reduced the number of hours worked per week. Incidents were identified by means of a multidisciplinary, four-pronged approach that included direct, continuous observation. Two physicians who were unaware of the interns' schedule assignments independently rated each incident. Results: During a total of 2203 patient-days involving 634 admissions, interns made 35.9 percent more serious medical errors during the traditional schedule than during the intervention schedule (136.0 vs. 100.1 per 1000 patient-days, P<0.001), including 56.6 percent more nonintercepted serious errors (P<0.001). The total rate of serious errors on the critical care units was 22.0 percent higher during the traditional schedule than during the intervention schedule (193.2 vs. 158.4 per 1000 patient-days, P<0.001). Interns made 20.8 percent more serious medication errors during the traditional schedule than during the intervention schedule (99.7 vs. 82.5 per 1000 patient-days, P=0.03). Interns also made 5.6 times as many serious diagnostic errors during the traditional schedule as during the intervention schedule (18.6 vs. 3.3 per 1000 patient-days, P<0.001). Conclusions: Interns made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts. Eliminating extended work shifts and reducing the number of hours interns work per week can reduce serious medical errors in the intensive care unit.
Keywords
Shift-work; Shift-workers; Health-care-personnel; Statistical-analysis; Surveillance-programs; Medical-personnel; Sleep-deprivation
Contact
Dr. Czeisler at the Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave., Boston, MA 02115
CODEN
NEJMAG
Publication Date
20041028
Document Type
Journal Article
Email Address
caczeisler@hms.harvard.edu
Funding Type
Grant
Fiscal Year
2005
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-007567
Issue of Publication
18
ISSN
0028-4793
Source Name
New England Journal of Medicine
State
MA
Performing Organization
Brigham and Women's Hospital
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