Interns' Compliance With Accreditation Council for Graduate Medical Education Work-Hour Limits

Landrigan, Christopher P.; Barger, Laura K.; Cade, Brian E.; Ayas, Najib; Czeisler, Charles A.

doi:10.1001/jama.296.9.1063

Cited by 138 publications

(84 citation statements)

References 14 publications

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“…Since studies of compliance with this work-hours regulation show that only a third of hospitals that have introduced compliance programs have actually used these programs to make the required change (Landrigan et al 2006), there must be a number of reasons for merely symbolic compliance. A claim that relational spaces are the only factor accounting for the difference in outcomes at these hospitals would not do justice to other possible conditioning factors that a comparative ethnographic study cannot detect.…”

Section: Future Researchmentioning

confidence: 99%

“…Despite these new resources, at many hospitals residents did not use the programs that were established for their benefit. A recent study documents that compliance by interns with the 80-hour-workweek regulation (i.e., averaging 80 work hours per week or less each month) during 2003-4 occurred in only 33% of general surgery residency programs (Landrigan et al 2006). To put it differently, merely ceremonial compliance in surgery occurred in 67% of hospitals.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Operating Room: Relational Spaces and Microinstitutional Change in Surgery

Kellogg

2009

American Journal of Sociology

452

469

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Section: Future Researchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Operating Room: Relational Spaces and Microinstitutional Change in Surgery

Kellogg

2009

American Journal of Sociology

452

469

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“…1 Resident well-being and patient safety were the main concerns relating to the excessive duty hours that residents sometimes worked prior to the 2003 changes. Even after these modifications, concerns remained about how compliant residents were with the duty hour rules, 2 and one rigorous study suggested that further reductions in maximum shift length could lead to safer patient care. 3 The Institute of Medicine (IOM) conducted an investigation in 2008 and published recommendations for further reductions in resident duty hours.…”

Section: Introductionmentioning

confidence: 99%

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

2011

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), bibliographies, pertinent reviews, and meeting abstracts. STUDY SELECTION: We included studies examining the relationship between the pre-and post-2003 time periods and patient outcomes (mortality, complications, errors), resident education (standardized test scores, clinical experience), and well-being (as measured by the Maslach Burnout Inventory). We excluded non-US studies. DATA EXTRACTION: One rater used structured data collection forms to abstract data on study design, quality, and outcomes. We synthesized the literature qualitatively and included a meta-analysis of patient mortality. RESULTS: Of 5,345 studies identified, 60 met eligibility criteria. Twenty-eight studies included an objective outcome related to patients; 10 assessed standardized resident examination scores; 26 assessed resident operative experience. Eight assessed resident burnout. Metaanalysis of the mortality studies revealed a significant improvement in mortality in the post-2003 time period with a pooled odds ratio (OR) of 0.9 (95% CI: 0.84, 0.95). These results were significant for medical (OR 0.91; 95% CI: 0.85, 0.98) and surgical patients (OR 0.86; 95% CI: 0.75, 0.97). However, significant heterogeneity was present (I 2 83%). Patient complications were more nuanced. Some increased in frequency; others decreased. Outcomes for resident operative experience and standardized knowledge tests varied substantially across studies. Resident well-being improved in most studies. LIMITATIONS: Most studies were observational. Not all studies of mortality provided enough information to be included in the meta-analysis. We used unadjusted odds ratios in the meta-analysis; statistical heterogeneity was substantial. Publication bias is possible. CONCLUSIONS:Since 2003, patient mortality appears to have improved, although this could be due to secular trends. Resident well-being appears improved. Change in resident educational experience is less clear.

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“…11,20 In the first year following implementation of the ACGME duty-hour standards, as many as 43% of interns reported noncompliance with these requirements. 21 This demonstrates that mandating work-hour reductions is only the first step in what is likely to be a long process of effecting change in nurse work hours and fatigue and, in turn, improving patient safety. However, initiating this process is going to be crucial, given the impact even small changes in nursing fatigue could have on patient-care outcomes.…”

Section: Discussionmentioning

confidence: 99%

Sleepiness in critical care nurses: Results of a pilot study

Surani

Subramanian

Babbar

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Sleep deprivation, compounded by circadian disruptions, is a common problem in health care workers. Sleepiness in nurses has important implications for patients as well as nurses' own safety.OBJECTIVE:The objective of the study was to assess comprehensively sleepiness levels in post‐night‐shift nurses.METHODS:Post‐night‐shift nurses in the ICU and on general floors (medicine and surgery) were assessed using subjective (Epworth Sleepiness Scale [ESS]) and objective (Mean Sleep Latency Test [MSLT]) measures.RESULTS:ESS was abnormal (>8) in 7 of 10 ICU nurses compared with 2 of 10 floor nurses (P < .005), and mean ESS score was also higher (8.7 ± 3.9 vs. 5.6 ± 2.1, respectively; P = 0.042). MSLT values for the first nap period were in the pathologic range in the ICU nurses compared with the floor nurses (4.65 ± 5.5 vs. 10.85 ± 7.4 minutes, respectively; P < .05).CONCLUSIONS:Post‐night‐shift RNs working in the ICU have a pathologic degree of sleepiness. Journal of Hospital Medicine 2008;3:200–205. © 2008 Society of Hospital Medicine.

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Interns' Compliance With Accreditation Council for Graduate Medical Education Work-Hour Limits

Abstract: In the first year following implementation of the ACGME duty-hour standards, interns commonly reported noncompliance with these requirements.

Cited by 138 publications

References 14 publications

Operating Room: Relational Spaces and Microinstitutional Change in Surgery

Operating Room: Relational Spaces and Microinstitutional Change in Surgery

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

Sleepiness in critical care nurses: Results of a pilot study

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