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When policy meets physiology: the challenge of reducing resident work hours.

Authors
Lockley-SW; Landrigan-CP; Barger-LK; Czeisler-CA; Harvard Work Hours Health and Safety Group.
Source
Clin Orthop Relat Res 2006 Aug; 449:116-127
NIOSHTIC No.
20031006
Abstract
Considerable controversy exists regarding optimal work hours for physicians and surgeons in training. In a series of studies, we assessed the effect of extended work hours on resident sleep and health as well as patient safety. In a validated nationwide survey, we found that residents who had worked 24 hours or longer were 2.3 times more likely to have a motor vehicle crash following that shift than when they worked < 24 hours, and that the monthly risk of a crash increased by 16.2% after each extended duration shift. We also found in a randomized trial that interns working a traditional on-call schedule slept 5.8 hours less per week, had twice as many attentional failures on duty overnight, and made 36% more serious medical errors and nearly six times more serious diagnostic errors than when working on a schedule that limited continuous duty to 16 hours. While numerous opinions have been published opposing reductions in extended work hours due to concerns regarding continuity of patient care, reduced educational opportunities, and traditionally-defined professionalism, there are remarkably few objective data in support of continuing to schedule medical trainees to work shifts > 24 hours. An evidence-based approach is needed to minimize the well-documented risk that current work hour practices confer on resident health and patient safety while optimizing education and continuity of care.
Keywords
Physiology; Workers; Physicians; Surgeons; Occupational-health; Sleep-deprivation; Sleep-disorders; Risk-factors; Risk-analysis; Shift-work; Shift-workers; Worker-health; Health-care; Health-care-personnel; Medical-care; Medical-personnel
CODEN
CORTBR
Publication Date
20060801
Document Type
Journal Article
Email Address
slockley@hms.harvard.edu
Funding Type
Grant
Fiscal Year
2006
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-007567
ISSN
0009-921X
Source Name
Clinical Orthopaedics and Related Research
State
MA
Performing Organization
Brigham and Women's Hospital
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