Current Accreditation Council for Graduate Medical Education (ACGME) duty hour regulations limit resident work hours (no more than 80 hours per week or 24-28 consecutive hours on duty) in an effort to improve both resident and patient safety. This nationally representative survey found that over 90% of US adults disagree with the current duty hour policies, with 66% of respondents supporting additional limits on duty hours (to no more than 40 hours per week or 12 consecutive hours).

Parents of children with medical complexity can offer unique perspectives on hospital quality and safety. Prior to their child's discharge, parents were surveyed about their child's care, medications, safety, and other concerns experienced during their stay. Parents reported experiencing miscommunication with the providers and providers seemingly not communicating with each other. They also reported inconsistency in care/care plans, unmet expectations, lack of transparency, and a desire for their expertise to be taken seriously.

The Accreditation Council for Graduate Medical Education (ACGME) restrictions on resident work hours have improved resident well-being, but the impact on education, clinical and patient safety outcomes is less clear. This meta-analysis found that the 2003 ACGME restrictions (limiting residents to 80-hour work weeks and 28-hour shifts) was associated with an 11% reduction in mortality; however, there was no significant difference in mortality after the 2011 restrictions (limiting first-year residents to 16-hour shifts). These findings reinforce the impact of extended resident physician work hours and patient morbidity and mortality. The authors also recommend that future research examine the relationship between work hours and patient outcomes among other health care workers.

Diagnostic errors remain a major healthcare concern. This study was a retrospective record review of 882 pediatric intensive care unit (PICU) patients to identify diagnostic errors using the Revised Safer Dx tool. Diagnostic errors were found in 13 (1.5%) patients, most commonly associated with atypical presentation and diagnostic uncertainty at admission.

The Accreditation Council for Graduate Medical Education (ACGME) in the United States limits resident physicians' workweek to 80 hours. Several studies have investigated the association between first year residents (i.e., interns, PGY1), worked hours and patient safety. This study includes residents beyond the first year (i.e., PGY2+). Nearly 5,000 PGY2+ residents reported the number of hours worked, patient safety outcomes, and resident health and outcomes. Working more than 60 hours in a week significantly increased the risk of a medical error resulting in patient death. The authors suggest weekly workweek limits should be significantly reduced, such as they are in the United Kingdom.

Fatigue and sleep deprivation among healthcare workers can increase the risk of errors. This prospective study including 60 attending surgeons from departments of surgery or obstetrics and gynecology at eight hospitals found that sleep deficiency was not associated with greater numbers of errors during procedures performed the next day. However, non-technical skill performance, situational awareness, and decision making were adversely associated with sleep deficiency.  

I-PASS, a structured hand-off tool, can reduce preventable adverse events during transitions of care. Previously published studies have shown that Patient and Family-Centered (PFC) I-PASS rounds reduced preventable and non-preventable adverse events (AE) in hospitalized children. This study presents additional analysis, comparing AE rates in children with complex chronic conditions (CCC) to those without. Results show a reduction in AE in both groups, with no statistically significant differences between the groups, suggesting PFC I-PASS may be generalizable to broader groups of patients without needing modification.

I-PASS is a structured handoff tool to enhance communication during patient transfers and improve patient safety. This study found that I-PASS implementation at 32 hospitals decreased major and minor handoff-related adverse events and improved key handoff elements (e.g., frequency of handoffs with high verbal quality) across provider types and settings.

Children with serious medical conditions are vulnerable to medical errors. This prospective study examined safety reporting behaviors among parents of children with medical complexity and hospital staff caring for these patients in one tertiary children’s hospital. Findings indicate that parents frequently identify medical errors or quality issues, despite not being routinely advised on how to report safety concerns.

Patient and family engagement in safety efforts is supported in research but patients and clinicians still experience barriers in providing and accepting feedback. In this study, parents and caregivers of medically complex children reported uncertainty about whether and to whom to report concerns. Other themes included misalignment of staff and parent expectations of care and staff and leadership buy-in on the value of parent engagement.

… proficiency patients and families are presented. … Khan A, Parente V, Baird JD, et al. Association of patient and …

… Council for Graduate Medical Education (ACGME) introduced a 16-hour shift limit for first-year residents. Recent … in patient death (63% risk reduction). … Weaver MD, Landrigan CP, Sullivan JP, et al. National improvements in … resident physicians' extended duration work shifts: a pooled analysis of prospective cohort studies. BMJ Qual …

… significant morbidity and mortality to patients and play a role in malpractice claims. 498 closed malpractice claims … in nearly half. Of the communication errors that involved a failed handoff (47%), the majority could have potentially been prevented with a structured handoff tool.  … Humphrey KE,  Sundberg M, …

… and retrospective chart review to examine 5927 orders over a 12-month period, 538 were included in the analysis. Key … safety initiatives in the future. … Chiel L, Freiman E, Yarahuan J, Parsons C, Landrigan CP, Winn AS. Changes made to orders placed by …

Reducing resident shift duration can improve resident health and patient safety. This study found that resident shifts limited to 16 hours can reduce performance impairment and medical errors, compared to extended work shifts (24+hours).

Fatigue among health care workers can increase risk of errors. This study posited that blue-enriched light could promote alertness and attention and thereby reduce medical errors in the ICU; however, the authors did not identify any effect of this intervention on error rates.  

… … Language barriers between patients and providers is a potential contributor to adverse events . Based on a cohort of 1,666 Arabic-, Chinese-, English-, and … and safety for this vulnerable group of children. … Khan A, Yin HS, Brach C, et al. Association between parent comfort …

… adults; young adults; and persons with disabilities. … Czeisler M, Marynak K, Clarke KEN, et al. Delay or avoidance of medical care …

This multicenter cluster randomized trial explored the impact of eliminating extended-duration  work schedules (shifts in excess of 24 hours) on serious medical errors made by residents in the pediatric intensive care unit (ICU). The authors found that residents in ICUs which eliminated extended shifts in favor of day and night shifts of 16 hours or less made significantly more serious errors than residents assigned to extended-duration work schedules. The authors observed that the resident-to-patient ratio was higher during schedules which eliminated extended shifts, but also that these results might have been confounded by concurrent increases in workload in ICUs eliminating extended shifts.

This article presents longitudinal follow-up of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial, which examined the effects of flexible duty-hour policies on resident outcomes. After four years, there was no evidence of increased duty-hour violations, decreased satisfaction or decreased well-being among residents randomized to flexible duty-hour policies. The researchers also observed that the beneficial impacts of flexible duty-hours persisted over the four-year period, whereas most of the negative effects diminished over time.