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Weinstein DF, Arora V, Drolet B, Reynolds EE. N Engl J Med. 2013;369:e32.
The implementation of resident duty hours over the past decade has been controversial. The New England Journal of Medicine hosted a roundtable discussion exploring the effects of duty hour regulations on residency training. Moderated by Dr. Debra Weinstein, the discussion featured Dr. Vineet Arora, Dr. Eileen Reynolds, and surgical resident Dr. Brian Drolet as panelists. The discussants noted the evidence for patient safety after duty-hour restrictions has not been as robust as people had predicted. They also focused on the increase in supervision, changes in sense of professionalism, and challenges of handoffs that have followed duty hours. Accompanying the video are two perspective articles written by physicians from different generations describing the benefits and drawbacks of their overnight experiences. A recent AHRQ WebM&M perspective and interview also discussed the potential impact of resident duty hours on patient safety.
Journal Article > Review
Hospital board oversight of quality and patient safety: a narrative review and synthesis of recent empirical research.
Millar R, Mannion R, Freeman T, Davies HTO. Milbank Q. 2013;91:738-770.
Hospital leadership oversight is thought to be critical for advancing patient safety initiatives. This narrative review synthesized 122 studies examining the role of hospital board oversight in fostering safety practices. Investigators found that high-performing hospitals are more likely to have skilled board members and standardized board processes compared with low-performing hospitals, highlighting the value of effective and committed leadership that prioritizes quality and safety improvement. However, more research is needed to determine optimal hospital governance. A past AHRQ WebM&M interview discussed the role of leadership and medical administration in patient safety.
Journal Article > Study
Drolet BC, Christopher DA, Fischer SA. N Engl J Med. 2012;366:e35.
Over the past decade, increasing duty-hour regulations for resident physicians have been motivated by efforts to improve patient care, resident education, and resident quality of life. Despite mixed results in achieving those goals, the 2011 regulations extended the work hour limits further and added a significant cost burden to teaching institutions in covering provider gaps. This survey study captured more than 6200 responses from a diverse group of resident physicians to assess the impact of the newest regulations. Overall, nearly half the residents disapprove of the regulations, and nearly 60% report that their hours worked are unchanged compared to last year. Other notable findings included that 43% reported no change in the quality of care, more than half believed preparation for more senior roles was worse, and only 16% believed education was improved. Not surprisingly, 72% reported increased handoffs, and only interns reported improvements in their quality of life. The authors conclude that a one-size-fits-all approach that comes with such regulations may not meet the needs of all trainees or training environments.