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Search results for "Discontinuities, Gaps, and Hand-Off Problems"
Journal Article > Study
Nuckols TK, Bhattacharya J, Miller Wolman D, Ulmer C, Escarce JJ. N Engl J Med. 2009;360:2202-2215.
A recent Institute of Medicine (IOM) report recommended significant changes to resident physicians' work hours to improve patient safety. These recommendations included eliminating extended duration shifts or scheduling nap times during extended shifts, decreasing resident workload, and strictly adhering to the 80-hour weekly work limits originally implemented in 2003. The implementation of the IOM recommendations would cost teaching hospitals approximately $1.6 billion, according to this analysis. However, due to a lack of clear evidence on the safety effects of duty-hour reduction, the authors were unable to accurately estimate the cost savings to society if adverse events were reduced. The accompanying editorial notes the relative lack of evidence supporting additional duty-hour reductions and calls for further study of the relationship between duty hours, handoffs, and patient safety.
Journal Article > Commentary
Volpp KG, Landrigan CP. JAMA. 2008;300:1197-1199.
The Accreditation Council for Graduate Medical Education's 2003 regulations limiting housestaff duty hours have generated an expansive field of research into their impact on fatigue, workload, clinical outcomes, and patient safety. This commentary aims to put the current research into a practical context and provides eight priorities that should guide teaching institutions in their efforts to balance both physician and patient safety. The authors highlight alternative staffing models (e.g., no more 24-hour shifts), improved sign-out procedures, greater monitoring and evaluation of duty hour changes, the importance of adequate supervision and workload intensity, and better designed financial incentives to promote successful policy change. The Agency for Healthcare Research and Quality (AHRQ) has sponsored an Institute of Medicine (IOM) committee to review the important research and related issues around work hour restrictions.
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.