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Basner M; Asch DA; Shea JA; Bellini LM; Carlin M; Ecker AJ; Malone SK; Desai SV; Sternberg AL; Tonascia J; Shade DM; Katz JT; Bates DW; Even‑Shoshan O; Silber JH; Small DS; Volpp KG; Mott CG; Coats S; Mollicone DJ; Dinges DF; iCOMPARE Research Group.
This cluster-randomized trial compared an internal medicine residency schedule that adhered to 2011 duty hour regulations to a flexible schedule that maintained an overall 80-hour work week. Self-reported sleepiness and measured sleep duration did not differ by group, but residents in the flexible programs performed worse on psychomotor vigilance testing, a measure of alertness. The authors recommend implementing fatigue-management training during residency.
Gates M, Wingert A, Featherstone R, et al. BMJ Open. 2018;8:e021967.
Fatigue among health care workers is a well-established safety issue that can increase risk of errors. Investigators conducted a systematic review to examine the effects of fatigue on both providers and patients, as well as the impact of efforts designed to mitigate fatigue. They ultimately included 47 studies in their analysis, 28 of which demonstrated a relationship between fatigue or inadequate sleep and physician health outcomes. Looking at six cohort studies and patient outcomes, they found no difference in patient mortality or postoperative complications between surgeons who were and were not sleep deprived. A past PSNet interview discussed how research on sleep deprivation among residents has informed duty hour changes.
Carthon MB, Hatfield L, Plover C, et al. J Nurs Care Qual. 2019;34:40-46.
This cross-sectional study found that nurses reporting a lower level of engagement also described worse patient safety in their work environment. These concerns were exacerbated when higher patient–nurse staffing ratios were present. The authors suggest that increasing nurse engagement may improve patient safety.
Patterson ES. Hum Factors. 2018;60:281-292.
Poor design of health information technology can lead to miscommunication, burnout, and inappropriate documentation. This review of the literature identified three practice deviations associated with health IT, including workflow disruption, inappropriate use of text fields, and use of handwritten paper or whiteboard notes instead of health IT. The author recommends improvements focused on electronic health record display to enhance communication.