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Search results for "Active Errors"
- Active Errors
- Fatigue and Sleep Deprivation
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Journal Article > Study
The impact of the 2011 Accreditation Council for Graduate Medical Education duty hour reform on quality and safety in trauma care.
Marwaha JS, Drolet BC, Maddox SS, Adams CA Jr. J Am Coll Surg. 2016;222:984-991.
Current studies suggest that the ACGME duty hours reform in 2011 did not substantially affect patient outcomes. Consistent with prior work, this retrospective cohort study found no differences in primary outcomes such as mortality. However, the authors suggest that future studies examine other quality metrics that may have changed after the duty-hours reform.
Journal Article > Study
Complications of daytime elective laparoscopic cholecystectomies performed by surgeons who operated the night before.
- Classic
Vinden C, Nash DM, Rangrej J, et al. JAMA. 2013;310:1837-1841.
Considerable research has shown that sleep deprivation can affect cognitive performance, but the link between fatigue and clinical outcomes, particularly for surgeons, remains unclear. This case-control study sought to determine whether there was an association between sleep deprivation—defined as having performed an emergency procedure the night before—and complication rates for elective laparoscopic cholecystectomy. Although a prior single-institution study found increased complication rates for daytime procedures performed after operating the night before, this study used a much larger population-based database from Ontario, Canada and found no evidence of greater complications in patients whose surgeons had operated the night before. As duty hour restrictions for resident physicians appear to have had no effect on clinical outcomes, this study provides an argument against restricting practicing physician's duty hours.
Journal Article > Commentary
Sleep deprivation: a call for institutional rules.
McKenna L, Kodner IJ, Healy GB, Keune JD. Surgery. 2013;154:118-122.
This commentary illustrates the ethics around three potential tactics to address surgeons with fatigue.
Journal Article > Study
Do micropauses prevent surgeon's fatigue and loss of accuracy associated with prolonged surgery? An experimental prospective study.
Dorion D, Darveau S. Ann Surg. 2013;257:256-259.
Taking micropauses—a 20-second break every 20 minutes during a surgical procedure—was associated with lower levels of fatigue among surgeons.
Perspectives on Safety > Perspective
Balancing Supervision and Autonomy: An Ongoing Tension
with commentary by C. Jessica Dine, MD, MA; and Jennifer S. Myers, MD, Resident Supervision and Patient Safety, February 2012
This piece discusses how increased supervision influences the educational experience for trainees.
Journal Article > Study
Factors associated with medication errors in the pediatric emergency department.
Vilà-de-Muga M, Colom-Ferrer L, Gonzàlez-Herrero M, Luaces-Cubells C. Pediatr Emerg Care. 2011;27:290-294.
Prescribing errors in a pediatric emergency department were more frequent on weekends and at night, and residents committed errors more frequently than attending physicians.
Perspectives on Safety > Interview
In Conversation with…Pat Croskerry, MD, PhD
Patient Safety in Emergency Medicine, June 2010
Pat Croskerry, MD, PhD, is a professor in emergency medicine at Dalhousie University in Halifax, Nova Scotia, Canada. Trained as an experimental psychologist, Dr. Croskerry went on to become an emergency medicine physician, and found himself surprised by the relatively scant amount of attention given to cognitive errors. He has gone on to become one of the world's foremost experts in safety in emergency medicine and in diagnostic errors. We spoke to him about both.
Journal Article > Study
The impact of prolonged continuous wakefulness on resident clinical performance in the intensive care unit: a patient simulator study.
Sharpe R, Koval V, Ronco JJ, et al. Crit Care Med. 2010;38:766-770.
This study discovered that the clinical performance of medical residents deteriorates during prolonged hours of activity, suggesting the need for reform around current regulations for resident work hours.
Journal Article > Commentary
Patient safety and collaboration of the intensive care unit team.
Despins LA. Crit Care Nurse. April 2009;29:85-91.
This article describes how patient safety and team coordination in the ICU are connected. The author recommends team training as an approach to enhance collaboration.
Newspaper/Magazine Article
Doctor dozed during surgery, report says Beth Israel faulted in case.
Kowalczyk L. Boston Globe. March 25, 2009;Metro:1.
Reporting on an incident in which a sleepy surgeon operated on a patient, this article addresses safety and cultural issues surrounding impaired physicians.
Cases & Commentaries
Do Not Disturb!
- Spotlight Case
- Web M&M
F. Daniel Duffy, MD; Christine K. Cassel, MD; October 2007
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.
Newspaper/Magazine Article
Night shift nightmare.
Alexander M. Reader's Digest. June 2007.
This article reports on the potential for medical errors to occur during the night shift and the factors that contribute to these mistakes.
Journal Article > Study
Effects of sleep inertia on cognition.
Wertz AT, Ronda JM, Czeisler CA, Wright KP Jr. JAMA. 2006;295:163-164.
This research letter reports on sleep inertia and how it can affect cognitive performance for individuals abruptly awoken and immediately required to make decisions.
Newspaper/Magazine Article
Junior medics bullied to lie about hours: doctors ordered to work without proper training.
Revill J. The Observer. May 15, 2005.
This article describes how reduced work hours for physicians in the United Kingdom may be leaving hospitals understaffed at night. Some junior doctors report being asked to perform duties for which they have not been trained.
Perspectives on Safety > Interview
In Conversation with…Christopher P. Landrigan, MD
April 2005
In October 2004, in what immediately became a landmark paper in patient safety, Dr. Landrigan and his colleagues reported the results of their study on sleep deprivation and medical errors among interns. The AHRQ-funded study, published in the New England Journal of Medicine, revealed 36% more serious errors and 5.6 times more serious diagnostic errors among interns working a traditional schedule of more than 24 hours in a row than among interns working shorter shifts (1). We spoke with Dr. Landrigan, an Assistant Professor of Pediatrics at Harvard Medical School, about his research and his thoughts on how the study findings might affect residency training in the future.