Shapiro DE, Duquette C, Abbott LM, et al. Am J Med. 2019;132:556-563.
Physician burnout is a persistent problem that can have serious effects on safe practice. This review discusses a model to prioritize interventions to address physician burnout. The approach suggests actions at five levels: physical and mental health; safety and security; respect; appreciation and connection; and the ability to fully contribute to care.
Nurok M, Czeisler CA, Lehmann LS. N Engl J Med. 2010;363:2577-9.
This commentary discusses complications with rescheduling elective procedures due to surgeon sleep deprivation and encourages the evaluation of policy solutions to inform patients and families of provider fatigue.
The Accreditation Council for Graduate Medical Education's 2003 regulations limiting housestaff duty hours have generated an expansive field of research into their impact on fatigue, workload, clinical outcomes, and patient safety. This commentary aims to put the current research into a practical context and provides eight priorities that should guide teaching institutions in their efforts to balance both physician and patient safety. The authors highlight alternative staffing models (e.g., no more 24-hour shifts), improved sign-out procedures, greater monitoring and evaluation of duty hour changes, the importance of adequate supervision and workload intensity, and better designed financial incentives to promote successful policy change. The Agency for Healthcare Research and Quality (AHRQ) has sponsored an Institute of Medicine (IOM) committee to review the important research and related issues around work hour restrictions.
Following surgery, a woman on a patient-controlled analgesia pump is found to be lethargic and incoherent, with a low respiratory rate. The nurse contacted the attending physician, who dismisses the patient's symptoms and chastises the nurse for the late call.
This series includes articles on "doorway diagnosis" (or a doctor's assessment of a patient before an exam begins), anesthesiologists addicted to painkillers, and medical mistakes in the emergency room.
Hutter MM, Kellogg KC, Ferguson CM, et al. Ann Surg. 2006;243:864-71; discussion 871-5.
Since implementation of Accreditation Council for Graduate Medical Education (ACGME) resident duty hour restrictions, several studies have discussed the changes from a policy standpoint, a cost perspective, and with respect to patient safety. This study discovered that although resident quality of life improved, there was no impact on quality of patient care, and several concerns were raised about the training of future surgeons. These concerns included a change toward a shift-worker mentality with less patient focus, decreased continuity of care, and erosion of the doctor-patient relationship. Investigators used a combination of time card assessments, Web-based surveys, and individual interviews to draw their conclusions.
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