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Search results for "Discontinuities, Gaps, and Hand-Off Problems"
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 > Commentary
Collins Sharp BA, Clancy CM. J Nurs Care Qual. 2008;23:97-100.
This AHRQ commentary describes research findings linking nurses' working environment (including organizational climate, staffing, overtime, and fatigue) to patient outcomes.
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 > Review
Caruso CC, Bushnell T, Eggerth D, et al. Am J Ind Med. 2006;49:930-942.
The authors reviewed literature and sought expert opinion to identify the reasons for and effects of long working hours, then identified research needed to pinpoint employee groups most at risk for negative consequences.
Thompson D, Holzmueller C, Hunt D, Cafe C, Sexton B, Pronovost PJ. Jt Comm J Qual Patient Saf. 2005;31:476-479.
The authors describe a tool to support reliable communication at shift change and promote improved patient safety. The project was supported by the Agency for Healthcare Research and Quality (AHRQ).