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Literature review shows reduced work hours have mixed results for safety

Patient Safety Monitor Alert, January 17, 2005

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Reducing resident hours does not affect patient mortality, according to a literature review of studies evaluating the impact of sleep on patient safety, published in Annals of Internal Medicine, December 7.

Yet, a study by Harvard Work Hours and Health Study, published on October 28, 2004 in the New England Journal of Medicine, concluded that fatigue is a primary factor behind medical errors, according to an article by American Medical News.

"There's been a general perception that by decreasing work hours, by definition we'll be improving patient safety," says leader of the literature review Kathlyn E. Fletcher, MD, assistant professor of internal medicine at the Medical College of Wisconsin and a clinician-researcher at the VA Medical Center in Milwaukee. "This review shows that can happen, but it doesn't always happen. You must do it in a manner that still provides excellent patient care."

David F. Dinges, PhD, professor of psychology at the University of Pennsylvania School of Medicine, said there were many factors that could increase medical risks, which may explain the disparate research results. "I think it's fine if there's some controversy over the evidence and what to do about it," said Dinges. "Everybody assumes that the hours the [Accreditation Council for Graduate Medical Education] imposed will take care of the matter, but this is just the beginning."

More research is needed to accurately provide a picture of the revised resident hours, he said. "If you can't solve the acute throughput, the sheer volume of patients coming through the hospital, we'll have errors," said Dinges. "...If we want all those hours of patient care and have a limited number of people giving them, then we need to find a way to use technology to prevent errors."

To read the American Medical News article, click here.

To read the abstact of the literature review in the Annals of Internal Medicine, click here.

To read the Harvard Work Hours and Health Study in the New England Journal of Medicine, click here.

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