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Approach to Improving Safety
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Search results for "United States of America"

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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.

Audiovisual > Audiovisual Presentation

Sleep Deprivation, Health Care Providers, and Patient Safety.

National Patient Safety Foundation. February 27, 2017; 1:00–2:00 PM (Eastern).

Lack of sleep and long work hours hinder safety and can contribute to medical error. This webinar will review the evidence examining fatigue as a patient safety hazard. Dr. Christopher P. Landrigan will be the featured speaker.

Book/Report

Surgeon, Heal Thyself: Optimising Surgical Performance by Managing Stress.

Shiralkar U. Boca Raton, FL: CRC Press; 2017. ISBN: 9781498724036.

Stress, information overload, and high-risk decisions are prevalent in surgery. This book discusses elements of surgical practice that can diminish surgeon performance and contribute to burnout. The author offers recommendations for surgeons to help manage stress levels, including noise reduction, ergonomic considerations, and recognition of fatigue.

Journal Article > Study

A work systems analysis approach to understanding fatigue in hospital nurses.

Steege LM, Pasupathy KS, Drake DA. Ergonomics. 2017 Jan 23; [Epub ahead of print].

Prior research shows that nurse fatigue contributes to medical error, placing patient safety at risk. Investigators performed a secondary analysis of survey data from 340 inpatient nurses to determine how different aspects of the work system—person, tasks, environment, organization, and tools and technology—affect nurse fatigue and recovery. They conclude that a work systems approach leads to a better understanding of occupational fatigue and carries important implications for improving safety.

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

Fatigue in hospital nurses—'Supernurse' culture is a barrier to addressing problems: a qualitative interview study.

Steege LM, Rainbow JG. Int J Nurs Stud. 2017;67:20-28.

Nurse fatigue is associated with omissions and errors in care. This qualitative study found that nursing professional culture in its current state poses a challenge to effectively mitigating fatigue among nurses. The authors advocate for future research to develop culture change models and strategies that address these barriers.

Journal Article > Review

Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout.

Shanafelt TD, Noseworthy JH. Mayo Clin Proc. 2017;92:129-146.

Clinician burnout can affect the safety of teamwork and care delivery. This review suggests that focusing solely on individual behaviors is insufficient to reduce burnout in health care. The authors discuss how organizational strategies that encourage physician engagement can address burnout and its negative effects.

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 > Commentary

Health care worker fatigue.

Gardner LA, Dubeck D. Am J Nurs. 2016;116:58-62.

Fatigue can contribute to human error. This commentary discusses incidents reported to Pennsylvania Patient Safety Reporting System that demonstrate the impact of fatigue on nursing care. The authors introduce guidelines that focus on shared accountability to mitigate health care worker fatigue, including individual habits and organizational responsibilities.

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 > Commentary

Alarm management: promoting safety and establishing guidelines.

Criscitelli T. AORN J. 2016;103:518-521.

Alarms contribute to distractions, fatigue, and lack of concentration, which can result in patient harm. This commentary examines the problem in ambulatory surgery centers and summarizes resources and recommendations currently available to help staff manage alarms in this setting.

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 > Commentary

The effect of staff nurses' shift length and fatigue on patient safety and nurses' health: from the National Association of Neonatal Nurses.

Samra HA, Smith BA. Adv Neonatal Care. 2015;15:311.

Nurses' work-related fatigue has the potential to contribute to medication errors and missed nursing care. This position statement provides recommendations for neonatal nurses and their employers to reduce risks related to long work shifts.

Journal Article > Commentary

Sleep deprivation and starvation in hospitalised patients: how medical care can harm patients.

Xu T, Wick EC, Makary MA. BMJ Qual Saf. 2016;25:311-314.

This commentary explores elements of the hospital environment that can contribute to sleep deprivation and malnutrition in patients, including care complexity, hospital census, poor communication, and noise. The authors advocate for designing more patient-centered hospital systems to prevent this type of harm.

Journal Article > Study

Early impact of the 2011 ACGME duty hour regulations on surgical outcomes.

Scally CP, Ryan AM, Thumma JR, Gauger PG, Dimick JB. Surgery. 2015;158:1453-1461.

Duty hour reform was enacted to improve patient safety, but its effect remains unclear. This study found no difference in surgical complication rates before and after implementation of 2011 duty hour reforms, using nonteaching hospitals as a reference population. These results add to the literature suggesting that duty hours had no substantial impact on patient outcomes.

Audiovisual

Training Program for Nurses on Shift Work and Long Work Hours.

Caruso CC, Geiger-Brown J, Takahashi M, Trinkoff A, Nakata A. Cincinnati, OH: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; May 2015. DHHS NIOSH Publication No. 2015-115.

Nurse fatigue has been associated with diminished decision-making skills that can contribute to patient harm. This online training program for clinicians and administrators will explore hazards related to nurse fatigue and provide strategies to address behaviors and systems that increase these risks.

Journal Article > Study

Call-shift fatigue and use of countermeasures and avoidance strategies by certified registered nurse anesthetists: a national survey.

Domen R, Connelly CD, Spence D. AANA J. 2015;83:123-131.

Certified registered nurse anesthetists (CRNAs) do not have formal restrictions on their work hours. This survey found that more than half of CRNAs worked extended duration (greater than 16 hour) shifts, and nearly one-third reported committing a medical error due to fatigue.

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