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Peterson C, Moore M, Sarwani N, et al. Diagnosis (Berl). 2021;8:368-372.
Recent duty hour reforms are intended to improve patient safety and resident well-being. This study explored whether resident performance declines as a function of consecutive overnight shifts, but results indicate no significant trend in overnight report discrepancies between the night float resident and the daytime attending.   

The Support and Services at Home (SASH®) program provides onsite assistance to help senior citizens (and other Medicare beneficiaries) remain in their homes as they age. Using evidence-based practices, a multidisciplinary, onsite team conducts an initial health assessment, creates an individualized care plan based on each participant’s self-identified goals, provides onsite nursing and care coordination with local partners, and schedules community activities to support health and wellness.

Havaei F, MacPhee M, Dahinten S. J Adv Nurs. 2019;75:2144-2155.
This study looked at the impact of two different models of delivering care by nurses, team versus total care, on quality of care and adverse events. The authors found that the team nursing model reported higher frequency of adverse events when there were licensed practical nurses on the team.
Price S, Lusznat R. The Clin Teach. 2018;15:240-244.
Teamwork is an important component of safety culture. This qualitative study found that medical and surgical trainees' perceptions of teams varied widely. The authors contend that the emergence of shift work may hinder trainees' ability to feel as if they are part of a team and can present a challenge to safety culture.
Bates CK, Yang J, Huang G, et al. Acad Med. 2016;91:60-4.
Residency training presents challenges to patient safety, including increased handoffs due to duty-hour reform. While residents are completing inpatient and outpatient training simultaneously, providing outpatients with continuity of care poses an additional complication. In this pre-post survey study, investigators found that separating inpatient and outpatient responsibilities for residents enhanced their perceptions of patient safety in both settings. This intervention also improved patient continuity (the proportion of visits for which residents saw their own patients); heightened continuity is thought to foster timely and accurate diagnosis. This study offers a replicable intervention to address some patient safety risks associated with medical residency. A previous WebM&M commentary discusses safety hazards and educational challenges related to academic year-end transfers.
Parshuram CS, Amaral ACKB, Ferguson ND, et al. CMAJ. 2015;187:321-9.
This randomized controlled trial of different resident shift lengths (12, 16, and 24 hours) sought to examine how duty hours affect patient safety, housestaff well-being, and handoffs. The authors found no effects on patient safety outcomes, including adverse events and mortality. This study adds to literature suggesting that decreasing duty hours does not improve safety for hospitalized patients.
DeRienzo CM, Frush K, Barfield ME, et al. Acad Med. 2012;87:403-10.
Reviewing evidence on transitions in care, this article describes how one university health system developed a comprehensive handoff curriculum to address educational needs in the context of changes to resident duty hours.
Vaughan L, McAlister G, Bell D. Clin Med (Lond). 2011;11:322-326.
This survey of physicians about the UK equivalent of the "July effect"—a tradition of nearly 50,000 new doctors starting on the first Wednesday in August—found a high degree of concern for patient care, safety, and training. The authors conclude that there is a need for structural changes.
A healthy elderly man presented to his primary care doctor—a third-year internal medicine resident—for routine examination. A PSA test was markedly elevated, but the results came back after the resident had graduated, and the alert went unread. Months later, the patient presented with new onset low back pain and was diagnosed with metastatic prostate cancer.
Moonesinghe SR, Lowery J, Shahi N, et al. BMJ. 2011;342:d1580.
Duty hours for resident physicians in the United States have been limited to 80 hours per week since 2003, but more stringent European regulations now limit trainees to 48 hours on duty each week. This systematic review concurred with another recent review in finding that the American regulations have not negatively impacted trainee or patient outcomes, but found that the impact of European regulations has not been adequately studied.
A man returns to the emergency department 11 days after hospital discharge in worsening condition. With no follow-up on a urine culture and sensitivity sent during his hospitalization, the patient had been taking the wrong antibiotic for a UTI.
Levine AC, Adusumilli J, Landrigan CP. Sleep. 2010;33:1043-53.
The most controversial aspect of the Accreditation Council for Graduate Medical Education's 2010 proposed regulations for resident physician work hours may be the elimination of traditional 24-hour shifts for first-year residents. This systematic review summarizes the existing evidence on eliminating these extended-duration shifts and finds that most studies reported improvements in resident education and quality of life, along with preserved or improved patient safety outcomes. However, all included studies were relatively small and conducted at single hospitals, and many had other important methodological limitations. A recent survey of residency program directors found that implementation of the proposed 16-hour shift limit will be challenging, as most programs do not currently adhere to this regulation.
Nasca TJ, Day SH, Amis S, et al. N Engl J Med. 2010;363:e3.
This article summarizes the Accreditation Council for Graduate Medical Education's proposed new regulations on housestaff duty hours. The recommendations are perhaps most notable for what they do not contain—a reduction in the 80-hour weekly limit. Rather than narrowly focusing on duty-hour restrictions, the recommendations take a broad approach to maximizing patient safety in training environments through targeted reductions in work hours for first-year residents, enhanced supervision by attending physicians, standardizing expectations around handoffs and signouts, and engaging residents in safety and quality improvement efforts. Although the current 80-hour work week will be preserved, the new regulations would eliminate extended-duration shifts for first-year residents (as was recommended in a 2008 Institute of Medicine report). The current regulations, implemented in 2003, have improved residents' quality of life but have not positively impacted patient safety or educational outcomes. The ACGME acknowledged this evidence in crafting recommendations that seek to establish a culture of safety within residency programs and focus more broadly on enhancing supervision for early-stage residents while allowing more autonomy for senior trainees.
Emergency medicine has evolved from a location, with variably trained and experienced providers ("the ER"), to a discipline with a well-defined knowledge base and skill set that focus on the diagnosis and care of undifferentiated acute problems.(1) The importance of rapid diagnosis and treatment of serious conditions (e.g., myocardial infarction, stroke, trauma, and sepsis) has made timeliness not simply a determinant of patient satisfaction but also a significant safety and quality concern—delays in care can be deadly.(2) Emergency physicians (EPs) have identified delays caused by crowding fr