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When policy meets physiology: The challenge of reducing resident work hours

Lockley, S.W., Landrigan, C.P., Barger, L.K. and Czeisler, C.A. (2006) When policy meets physiology: The challenge of reducing resident work hours Clinical Orthopaedics and Related Research (449). pp. 116-127.

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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. © 2006 Lippincott Williams &amp; Wilkins.

Item Type: Article
Authors :
Landrigan, C.P.
Barger, L.K.
Czeisler, C.A.
Date : 2006
DOI : 10.1097/01.blo.0000224057.32367.84
Uncontrolled Keywords : alertness, circadian rhythm, conference paper, diagnostic error, fatigue, human, job performance, learning, orthopedic surgery, patient care, patient safety, physiology, policy, priority journal, residency education, shift worker, sleep deprivation, surgeon, traffic accident, work schedule, fatigue, medical education, medical error, organization and management, pathophysiology, physiology, psychological aspect, review, sleep, time, Accidents, Traffic, Fatigue, Humans, Internship and Residency, Medical Errors, Organizational Policy, Sleep, Time Factors, Work Schedule Tolerance
Depositing User : Clive Harris
Date Deposited : 17 Jun 2020 01:56
Last Modified : 17 Jun 2020 01:56

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