Elimination of 24-hour continuous medical resident duty in Quebec

Hamadani, Fadi; Deckelbaum, Dan; Shaheen, Mohammed; Sauvé, Alexandre; Dumitra, Sinziana; Ahmed, Najma; Latulippe, Jean-François; Balaa, Fady; Walsh, Mark; Fata, Paola

doi:10.1503/cjs.007715

Cited by 8 publications

(9 citation statements)

References 5 publications

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“…The belief that sleep deprivation is largely to blame for the risks to residents’ occupational health and patient safety has led to reactionary measures by regulating bodies such as the ACGME (American Council for Graduate Medical Education), and provincial residency unions throughout Canada [5,11-12,14,23]. Duty hour restrictions have been established, limiting the number of consecutive hours worked or the total weekly hours worked.…”

Section: Discussionmentioning

confidence: 99%

Resident Physicians are at Increased Risk for Dangerous Driving after Extended-duration Work Shifts: A Systematic Review

Mak¹,

Li²,

Wiseman³

2019

Cureus

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Background: Resident physicians often work longer than 24 consecutive hours with little or no sleep. A systematic review of the literature was conducted to investigate the risk of resident physician motor vehicle collisions (MVC), and dangerous driving, after extended-duration work shifts (EDWS). Material and methods: A keyword search was performed for original research articles evaluating any aspect of driving safety following EDWS for the resident physician population. Two authors independently reviewed articles for inclusion. Subsequent independent data abstraction and quality appraisal were carried out. Five articles met the study inclusion criteria. Results: The quality of the evidence was low to very low. Results were not pooled due to study heterogeneity. Residents reported between 2.3 to 3.8 hours of sleep during EDWS. Three survey-based studies identified an increased risk of MVCs and falling asleep at the wheel after EDWS. One study associated weekly cumulative sleep hours lost with the risk of falling asleep while driving. Both driving simulation and survey studies linked EDWS with MVCs. Notably, a driving simulation study found an increase in crash frequency in male residents post-EDWS. Additionally, a survey reported that the risk of an MVC post-EDWS increased by 16.2% per shift worked in a month. Conclusion: The period following EDWS is associated with an increased risk of potentially life-threatening driving safety risks for resident physicians. These observations warrant careful consideration. They suggest that there is a need for greater awareness and action in order to avoid the occupational and public health risks of driving after EDWS.

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Section: Discussionmentioning

confidence: 99%

Resident Physicians are at Increased Risk for Dangerous Driving after Extended-duration Work Shifts: A Systematic Review

Mak¹,

Li²,

Wiseman³

2019

Cureus

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“…Indeed, recent studies have found that the Quebec reform had little effects on residents' self-reported fatigue, burnout, and quality of life. 14,15 Fourth, the beneficial effects of reducing the resident duty hours may have been counteracted by the adverse effects of increase in patient handoffs and losses on continuity of care.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, concerns have been raised by medical staff and residents that limiting the number of continuous hours requires more handoffs and may have detrimental effects on continuity of care. 14,15 The absence of any detrimental effects on patient outcomes may have several explanations. First, the increase in patient handoffs may have been compensated by an increase in the presence of an attending neonatologist.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, 16-hour shifts compared with 24-hour shifts have not been found to be associated with changes in quality of life or burnout. 9, 14,15 Introducing a more flexible call scheduling may have better impact on the quality of life than a single policy applied to all. 45 Second, programs and policy makers need to consider the academic impacts of changing resident duty hours on clinical exposure, autonomy, and technical abilities.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 On the other hand, concerns were raised that lack of continuity of care and higher number of handoffs required due to the change in work schedules may affect the outcomes adversely. 14,15 In Canada, the regionalization of perinatal care has led to centralization of Level 3 neonatal intensive care units (NICUs) in academic centers, where residents play an important role in the care of high-risk infants. 16,17 It has been suggested that outcomes of high-risk patients may better reflect resident involvement and be more sensitive to duty hour restrictions.…”

mentioning

confidence: 99%

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Association of Resident Duty Hour Reform and Neonatal Outcomes of Very Preterm Infants

et al. 2017

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Objective To assess the association of the 2011 Quebec provincial resident duty hour reform, which reduced the maximum consecutive hours worked by all residents from 24 to 16 hours, with neonatal outcomes. Study Design Retrospective observational study of 4,271 infants born between 23 and 32 weeks, admitted at five Quebec neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network (CNN) between 2008 and 2015 was conducted. Adjusted odds ratios (AORs) were calculated to compare mortality and the composite outcome of mortality or major morbidity before and after the implementation of the duty hour reform. Results The mortality rate was 8.4% (218/2,598) before the resident duty hour reform and 8.6% (182/2,123) after the reform (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.83–1.26). The composite outcome rate was 32% (830/2,598) before the duty hour reform and 29% (615/2,123) after the reform (OR = 0.87, 95% CI = 0.77–0.98). In the adjusted analyses, the resident call-hour reform was not associated with a significant change in mortality (AOR = 1.17, 95% CI = 0.91–1.50) or composite outcome (AOR = 0.87, 95% CI = 0.74–1.03). Conclusion Reducing residents' duty hours from 24 to 16 hours in Quebec was not associated with a difference in mortality or the composite outcome of very preterm infants.

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Fatigue in surgical residents an analysis of duty-hours and the effect of hypothetical naps on predicted performance

Schwartz

Hursh

Boyle

et al. 2021

The American Journal of Surgery

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Elimination of 24-hour continuous medical resident duty in Quebec

Cited by 8 publications

References 5 publications

Resident Physicians are at Increased Risk for Dangerous Driving after Extended-duration Work Shifts: A Systematic Review

Resident Physicians are at Increased Risk for Dangerous Driving after Extended-duration Work Shifts: A Systematic Review

Association of Resident Duty Hour Reform and Neonatal Outcomes of Very Preterm Infants

Fatigue in surgical residents an analysis of duty-hours and the effect of hypothetical naps on predicted performance

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