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Search results for "Fatigue and Sleep Deprivation"
Ulmer C, Wolman DM, Johns MME, eds. Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedule to Improve Patient Safety, Institute of Medicine. Washington, DC: The National Academies Press; 2008. ISBN: 9780309127721.
The 2003 regulations limiting housestaff work hours have had a profound impact on residency training. Although clinical outcomes appear to be unaffected, faculty and residents have expressed concern that education has been harmed, and the regulations' effect on patient safety remains unclear. The Institute of Medicine's report bases its recommendations on the growing body of research linking clinician fatigue and error, and recommends eliminating extended-duration shifts (defined as more than 16 hours), increasing days off, and improving sleep hygiene by reducing night duty and providing more scheduled sleep breaks. The report estimates that approximately $1.7 billion would be required to hire additional staff to allow residency programs to adhere to these recommendations. A related editorial discusses the balance between patient safety, resident safety, and resident education that was central to the development of these recommendations.
Journal Article > Study
Landrigan CP, Czeisler CA, Barger LK, et al. Jt Comm J Qual Patient Saf. 2007;33(suppl 1):19-29.
Efforts to comply with resident work-hour restrictions have placed a significant burden on hospitals and training programs, particularly in addressing the impact of these restrictions on patient safety. This AHRQ-supported study provides a framework to address the scheduling practices that aim to minimize sleep deprivation, optimize teamwork, and promote patient safety. The authors share a number of case examples and discuss policy implications around developing evidence-based scheduling and systematic culture change. This study's lead author, Dr. Christopher Landrigan, was featured in a past AHRQ WebM&M conversation that discussed the role of sleep deprivation in residency training and its effect on medical errors.
Journal Article > Commentary
Iglehart JK. N Engl J Med. 2008;359:2633-2635.
This editorial provides an overview of the 2008 Institute of Medicine recommendations for residency work hours, and discusses the relationship between duty hours and other important aspects of residency training such as supervision and patient handoffs. The article notes that the new recommendations represent a compromise between the sometimes competing objectives of improving patient safety, reducing resident workload and fatigue, and maintaining the quality of resident education.
Journal Article > Commentary
Putting the sleepy resident issue to bed: federal legislation is not the answer to excessive medical resident working hours.
Stone JD. Suffolk Univ Law Rev. 2007;40:745-767.
This article examines work-hour reduction and argues against federal regulation. The author contends that, to support safe care and avoid unintended consequences, reform efforts must not only limit hours but also augment resident supervision and foster high educational standards.