Evidence was emerging in 2003, and has been corroborated quite conclusively since then, that sleep deprivation negatively affects resident performance and safety. [1][2][3][4][5] Concerns over potential deleterious effects of sleep-deprived residents on patient care prompted efforts to reduce resident work hours. Duty hours limitations for all US residents were instituted by the Accreditation Council for Graduate Medical Education (ACGME) effective July 1, 2003, capping duty hours for most residents at 80 h/wk, mandating defined rest periods between assigned shifts, and limiting consecutive duty hours to 24 plus an additional 6 hours to transfer patient care, participate in educational activities, and attend outpatient clinics. 6 Initially implemented for most workers in 1993, the European Working Time Directive was extended to doctors in training in 2004, setting 13-hour shifts and initially 58 h/wk (to be further reduced to 48 h/wk after 5 years) as the maximum permissible for residents in the European Community. 7,8 In 2003 New Jersey was the first state to adopt Maggie's Law, 9 which upgraded vehicular homicide to a crime of the first degree when caused by a driver who was without sleep for a period in excess of 24 hours.The decision to embark on a major redesign of duty hours for the pediatric residency program at University of Medicine and Dentistry of New Jersey-New Jersey Medical This work was supported in part by a Title VII grant from the Health Resources Services Administration, Bureau of Health Professions, US Department of Health and Human Services, for Residency Training in Primary Care (D58HP05187). The funding agency had no role in data collection and analysis, the decision to publish, or manuscript preparation.The author thanks Dr Soyeon Kim for statistical support. Many thanks also go to the program's residents and faculty, current and former, for their ideas, enthusiasm, commitment to quality patient care, and willingness to embrace change.
AbstractBackground Sleep deprivation negatively affects resident performance, education, and safety. Concerns over these effects have prompted efforts to reduce resident hours. This article describes the design and implementation of a scheduling system with no continuous 24-hour calls. Aims included meeting Accreditation Council for Graduate Medical Education work hour requirements without increasing resident complement, maximizing continuity of learning and patient care, maintaining patient care quality, and acceptance by residents, faculty, and administration.
