Effect on Patient Safety of a Resident Physician Schedule without 24-Hour Shifts

Landrigan, Christopher P., Rahman, Shadab, Sullivan, Jason P., Vittinghoff, Eric, Barger, Laura, Sanderson, Amy L., Wright Jr., Kenneth P., O'Brien, Conor S., Qadri, Salim, St. Hilaire, Melissa A. et al, Halblower, 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, Stone, Katie L. and Czeisler, Charles A. (2020) Effect on Patient Safety of a Resident Physician Schedule without 24-Hour Shifts New England Journal of Medicine, 382. pp. 2514-2523.

Text 2020 Landrigan et al New Engl J Med [Incl suppl].pdf - Version of Record Restricted to Repository staff only until 26 December 2020. Download (4MB)

Abstract

Background: The effects on patient safety of eliminating extended-duration work shifts for resident physicians remain controversial. Methods: We 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. Results: The 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<0.001). The number of serious errors unitwide were likewise higher during the intervention schedules (181.3 vs. 131.5 per 1000 patient-days; relative risk, 1.56; 95% CI, 1.43 to 1.71). There was wide variability among sites, however; errors were lower during intervention schedules than during control schedules at one site, rates were similar during the two schedules at two sites, and rates were higher during intervention schedules than during control schedules at three sites. In a secondary analysis that was adjusted for the number of patients per resident physician as a potential confounder, intervention schedules were no longer associated with an increase in errors. Conclusions: Contrary to our hypothesis, resident physicians who were randomly assigned to schedules that eliminated extended shifts made more serious errors than resident physicians assigned to schedules with extended shifts, although the effect varied by site. The number of ICU patients cared for by each resident physician was higher during schedules that eliminated extended shifts.

Item Type:	Article
Divisions :	Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :	Name Email ORCID Landrigan, Christopher P. Rahman, Shadab Sullivan, Jason P. Vittinghoff, Eric Barger, Laura Sanderson, Amy L. Wright Jr., Kenneth P. O'Brien, Conor S. Qadri, Salim St. Hilaire, Melissa A. Halblower, 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 s.lockley@surrey.ac.uk Stone, Katie L. Czeisler, Charles A.
Date :	25 June 2020
Funders :	National Heart, Lung, and Blood Institute, National Institute of Occupational Safety and Health
DOI :	10.1056/NEJMoa1900669
OA Location :	https://www.nejm.org/doi/full/10.1056/NEJMoa1900669?query=featured_home
Grant Title :	National Heart, Lung, and Blood Institute
Copyright Disclaimer :	Copyright © 2020, Massachusetts Medical Society
Additional Information :	Embargo OK Metadata OK
Depositing User :	James Marshall
Date Deposited :	25 Jun 2020 09:50
Last Modified :	25 Jun 2020 09:50
URI:	http://epubs.surrey.ac.uk/id/eprint/858058

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