Weaver MD, Landrigan CP, Sullivan JP, et al. BMJ Qual Saf. 2022;Epub May 10.
In 2011, the Accreditation Council for Graduate Medical Education (ACGME) introduced a 16-hour shift limit for first-year residents. Recent studies found that these duty hour requirements did not yield significant differences in patient outcomes and the ACGME eliminated the shift limit for first-year residents in 2017. To assess the impact of work-hour limits on medical errors, this study prospectively followed two cohorts of resident physicians matched into US residency programs before (2002-2007) and after (2014-2016) the introduction of the work-hour limits. After adjustment for potential confounders, the work-hour limit was associated with decreased risk of resident-reported significant medical errors (32% risk reduction), reported preventable adverse events (34% risk reduction), and reported medical errors resulting in patient death (63% risk reduction).
Chen Y, Broman AT, Priest G, et al. Jt Comm J Qual Saf. 2021;47:165-175.
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.
Landrigan CP, Rahman SA, Sullivan JP, et al. N Engl J Med. 2020;382:2514-2523.
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.
Bittle MD, Knapp H, Polomano RC, et al. Jt Comm J Qual Patient Saf. 2019;45:337-347.
This report of a quality improvement study of infant drop risk found that mothers who fall asleep holding infants are more likely to drop them. Nursing observations and formal assessments of mothers' sleepiness prevented infant drops from occurring. The authors recommend frequent observation and direct assessment of maternal sleepiness for postpartum wards.
Hignett S, Otter ME, Keen C. Int J Nurs Stud. 2016;59:1-14.
Adverse events are thought to be common in patients receiving home health care. This systematic review defined home care safety risks for both patients and caregivers, including awkward working positions, social distractions, abuse and violence, and other issues that are relatively unique to this care setting.
This Web site provides access to materials for patient safety improvement efforts in Minnesota, including initiatives to reduce adverse drug events and hospital collaboratives to implement best practices.
Ardenne M, Reitnauer PG. Arzneimittel-Forschung. 1975;25:1369-79.
This special issue explores adverse events in nursing, including nurses' perceptions and attitudes towards adverse events, the effect of fatigue on shift work, and how to improve clinical decision making.
A considerable amount of attention has been paid to the issue of physician work hours and patient safety, thanks in part to regulations limiting duty hours for resident physicians. Fatigue has also been demonstrated to be a risk factor for errors among nurses, particularly when nurses work overtime or extended duration shifts. In this analysis, the authors found that among nurses, working voluntary overtime or working more than 40 hours per week were strongly correlated with an increase in self-reported errors, particularly needlestick injuries and medication errors. While legislative efforts have focused on restricting mandatory overtime for nurses, these results raise concern that the widespread practice of taking voluntary overtime shifts could negatively affect patient safety.
Shanafelt TD, Balch CM, Bechamps G, et al. Ann Surg. 2010;251:995-1000.
Duty-hour restrictions for resident physicians are intended to improve safety, but research in residents, nurses, and primary care physicians indicates that burnout and depression may be stronger predictors of substandard care than the number of hours worked. This survey of practicing surgeons revealed that 1 in 11 had committed a serious medical error within the past 3 months, and those who had committed an error were much more likely to meet criteria for burnout or depression. As in prior studies of surgeons, work hours were not correlated with likelihood of reporting an error, or being depressed. Although this survey could not determine if surgeons experienced emotional problems because of having committed an error or vice versa, it is well known that clinicians who commit errors experience substantial emotional distress, as discussed in an AHRQ WebM&M commentary.
Sixth Report of Session 2008–09. House of Commons Health Committee. London, England: The Stationery Office; July 3, 2009. Publication HC 151-I.
This government report analyzes the National Health Service's efforts to enhance patient safety and recommends improving certain areas, such as adopting technology, analyzing failure, and ensuring both practitioner education and adequate staffing.
Intern J Health Care Qual Assur. 2007;20(7):555-632.
This special issue includes articles by authors from Australia, Israel, France, Iran, and Belgium that explore ideas such as building a culture of safety, replacing medical equipment, and measuring safety improvements.
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