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Search results for "Hospitals"

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Newspaper/Magazine Article

Nurses seek to reduce long hours and fatigue.

Ungar L. USA Today. February 1, 2015.

This news article discusses problems associated with nurse fatigue and strategies hospitals are utilizing to prevent nursing staff from being overtired, such as paying nurses for scheduling flexibility and employing buddy systems to check each other's work.

Tools/Toolkit > Fact Sheet/FAQs

10 Patient Safety Tips for Hospitals.

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Rockville, MD: Agency for Healthcare Research and Quality; Revised December 2009. AHRQ Publication No. 10-M008.

This tip sheet provides 10 practical steps hospitals can undertake to improve patient safety, based on research funded by the Agency for Healthcare Research and Quality. The tips can be grouped into three areas: 1) reducing health care-acquired infections and retained surgical instruments through use of specific clinical practices; 2) improving drug safety by ensuring access to accurate drug information; and 3) improving the culture of safety through appropriate staffing and work hours for nurses and residents. These tips are based on high-quality research studies documenting the effectiveness of these interventions at reducing errors and improving safety for a broad range of patients.

Journal Article > Study

The perceived impact of duty hour restrictions on the residency environment: a survey of residency program directors.

Nuthalapaty FS, Carver AR, Nuthalapaty ES, Ramsey PS. Am J Obstet Gynecol. 2006;194:1556-1562.

The investigators surveyed residency directors on the perceived impact of work hour limitations on residency training. They found that a majority of program directors felt that the restrictions had a negative impact on resident education, had little or no impact on patient safety and quality, but improved the well being of residents.

Journal Article > Study

The impact of nursing work environments on patient safety outcomes: the mediating role of burnout engagement.

Spence Laschinger HK, Leiter MP. J Nurs Adm. 2006;36:259-267.

The investigators surveyed Canadian nurses to explore the relationship between ineffective working conditions and patient safety. Their findings suggest a correlation between a supportive working environment and high-quality, safe care.

Newspaper/Magazine Article

Medical residents angered at extended work hours.

Hurt J. Med Econ. April 26, 2017.

Discussions about resident work hours generate debate regarding safety and physician burnout. This magazine article reports resident physician concerns about the shift hour changes that allow for flexible duty hours within a maximum 80-hour workweek.

Journal Article > Commentary

Resident duty hours and medical education policy—raising the evidence bar.

Asch DA, Bilimoria KY, Desai SV. N Engl J Med. 2017;376:1704-1706.

The effect of resident work hours on patient safety has been controversial. This perspective summarizes the debate on resident duty hours in the context of recent changes to standards that allow for more flexibility in shift length. The authors underscore the importance of randomized trials, which investigators had utilized to explore the impact of flexible duty hours and served to inform the new policy.

Journal Article

On Patient Safety.

Lee MJ. Clin Orthop Relat Res. 2013-2017.

This quarterly commentary explores a wide range of subjects associated with patient safety, such as the impact of disruptive behavior on teams, the value of apologies, and work hour reforms. Older materials are available online for free.

Journal Article > Review

What is known: examining the empirical literature in resident work hours using 30 influential articles.

Philibert I. J Grad Med Educ. 2016;8:795-805.

Resident duty hours continue to create controversy as a patient safety improvement strategy. This narrative review examined key studies published between 1971 and 2013 to describe the evidence shaping the duty hour debate and identify areas in need of further research.

Journal Article > Study

Gender-based differences in surgical residents' perceptions of patient safety, continuity of care, and well-being: an analysis from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial.

Ban KA, Chung JW, Matulewicz RS, et al. J Am Coll Surg. 2017;224:126-136.e2.

Analyzing data from a prior trial of flexible versus traditional duty hours, this study found that female residents perceived patient safety as worse than male residents. Changes in duty hours had mixed effects on these self-reported outcomes and seemed to exacerbate gender differences. The authors recommend further study to determine how to improve learning for trainees regardless of gender.

Journal Article

Latest Results From the "FIRST" Trial.

J Am Coll Surg. 2017;224:103-159.

The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial examined residency program response to duty hour rules. This special issue features studies exploring effects of the initial trial including perceptions on the impact of a flexible 80-hour workweek on continuity of care and on physician well-being.

Legislation/Regulation

Summary of Proposed Changes to ACGME Common Program Requirements Section VI.

Accreditation Council for Graduate Medical Education.

Implementation of resident duty hours, meant to address fatigue in health care, has long been a subject of patient safety discussions. This website provides a summary of proposed changes to the current ACGME residency Common Program Requirements that shape working hours, offers rationale for the revisions.

Journal Article > Commentary

Ethical considerations in the development of the Flexibility in Duty Hour Requirements for Surgical Trainees trial.

Minami CA, Odell DD, Bilimoria KY. JAMA Surg. 2017;152:7-8.

Patient safety research has generated some concern regarding ethical implications involved in implementing changes that affect patient care. This commentary discusses ethical challenges related to a large trial that explored the effects of duty hour flexibility. The authors discuss policy changes, institutional review board roles, and informed consent as tactics to address concerns.

Book/Report

Bipartisan Consensus: The Public Wants Well-Rested Medical Residents to Help Ensure Safe Patient Care.

Almashat S, Carome M, Wolfe S, Landrigan CP, Czeisler C. Washington, DC: Public Citizen; September 13, 2016.

Duty-hour limitations have been implemented as a strategy to address resident fatigue, but they remain controversial. This report summarizes the results of a national poll that sought to assess public opinion regarding removing 16-hour shift restrictions and transparency around clinician work time.

Journal Article > Study

A reduced duty hours model for senior internal medicine residents: a qualitative analysis of residents' experiences and perceptions.

Mathew R, Gundy S, Ulic D, Haider S, Wasi P. Acad Med. 2016;91:1284-1292.

Although duty hour restrictions were enacted to improve patient safety, evidence regarding their impact has been mixed. This focus group study examined resident perceptions of quality of life and patient safety before and after implementation of a reduced duty hours model. Participants reported less fatigue but also expressed concern about the greater number of handoffs, echoing the ongoing duty-hours debate discussed in a recent PSNet perspective.

Journal Article > Review

Does clinical supervision of health professionals improve patient safety? A systematic review and meta-analysis.

Snowdon DA, Hau R, Leggat SG, Taylor NF. Int J Qual Health Care. 2016;28:447-455.

The patient safety movement catalyzed a well-known change in physician duty hours. A less known consequence of duty hour reform was an increase in clinical supervision for trainees. Although some studies have suggested that more clinical supervision leads to fewer adverse events, there were concerns that excessive trainee supervision impedes clinical learning. This systematic review examined how increased clinical supervision affects patient safety. Investigators found that complications from surgery and other invasive procedures were less likely when there was more supervision. Their data also indicated an overall mortality benefit associated with clinical supervision, but this result remains open to question because several of the included studies on mortality were of lower quality. At minimum, this meta-analysis argues for continued clinical supervision of surgeries and invasive procedures for optimal patient safety, as discussed in a previous PSNet perspective.

Journal Article > Commentary

Caregiver fatigue: implications for patient and staff safety—part 1 and part 2.

Blouin AS, Smith-Miller CA, Harden J, Li Y, Seaman CW. J Nurs Adm. 2016;46:329-335,408-416.

Nurse workload can contribute to burnout and diminish patient safety. This study found that rotating schedules were associated with higher reported fatigue among nurses. Introducing more breaks during shifts, limiting shift duration, and mandating 48-hour breaks between night-to-day rotations led to decreased nurse fatigue.

Journal Article > Study

Program director perceptions of surgical resident training and patient care under flexible duty hour requirements.

Saadat LV, Dahlke AR, Rajaram R, et al. J Am Coll Surg. 2016;222:1098-1105.

A recent cluster-randomized trial found no significant differences in patient outcomes or resident satisfaction between residency programs with flexible duty hours and those with standard duty hours. This survey examined surgical program directors' perceptions within this trial. Respondents from flexible duty hours programs reported a more positive effect of duty hours on patient safety, continuity of care, and attendance at educational activities. These results echo earlier studies that found clinical faculty had concerns about duty hour restrictions leading to a loss of educational opportunities, decreased continuity of care, and worsened resident–patient relationships.

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

National cluster-randomized trial of duty-hour flexibility in surgical training.

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Bilimoria KY, Chung JW, Hedges LV, et al. N Engl J Med. 2016;374:713-727.

Resident physician duty hour policies have generated rigorous debate, particularly following the most recent ACGME changes implemented in 2011, which shortened maximum shift lengths for interns and increased time off between shifts. This national study cluster-randomized 118 general surgery residency programs to adhere to current ACGME duty hour policies or to abide by more flexible rules that essentially followed the prior standard of a maximum 80-hour work week. Between these two groups, there were no significant differences in patient outcomes, including death and serious complications. Residents reported similar levels of satisfaction with their overall education quality and their well-being. An accompanying editorial notes that the study authors interpret these results as supporting flexible work-hour rules. Alternatively, the editorial author suggests that this study refutes concerns that the new policy compromises patient safety, and as such there is no compelling reason to backtrack on its implementation.

Journal Article > Study

Impact of the 2011 ACGME resident duty hour reform on hospital patient experience and processes-of-care.

Rajaram R, Saadat L, Chung J, et al. BMJ Qual Saf. 2016;25:962-970.

Using data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and the Hospital Compare website, this study did not find any significant differences between patient experience or processes-of-care scores in the year before compared to the year after the 2011 resident duty hour reforms.

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