Trial of shift scheduling with standardized sign-out to improve continuity of care in intensive care units*

Abstract

A shift-work schedule with structured sign-out curriculum is a viable alternative to traditional work schedules for the intensive care unit in training programs.

The Effect of Restricting Residents' Duty Hours on Patient Safety, Resident Well-Being, and Resident Education: An Updated Systematic Review

“…29,30,[33][34][35][36]41,43,46 A minority of studies found a favorable impact on resident well-being (4 of 17, 24%; TABLE 2). 32,33,45,48 When analyzed by intervention type, the most frequent result of shift length changes was no impact (8 of 20, 40%), 23,24,27,28,31,32,34,35 that of night float was an unfavorable impact (10 of 18, 56%), [35][36][37][38][39][41][42][43]46,47 and for protected time for sleep, 1 study reported a favorable outcome for resident wellness (1 of 2, 50%) 48 but no impact on patient care, while the other study was unfavorable for resident well-being (1 of 2, 50%). 49 …”

“…There were 27 studies included in the final review: 13 (48%) reviewed shift length, [23][24][25][26][27][28][29][30][31][32][33][34][35] 12 (44%) examined Across all of the studies and interventions, the impact of duty hour restrictions most frequently had no impact on patient care (5 of 10, 50%), 23,24,28,41,48 no impact on resident well-being (7 of 17, 41%), 27,34,35,41,44,46,49 and an unfavorable impact on resident education (9 of 14, 64%). 29,30,[33][34][35][36]41,43,46 A minority of studies found a favorable impact on resident well-being (4 of 17, 24%; TABLE 2).…”

“…5 As a set, the studies had consistent shortcomings in 4 of the 6 dimensions of MERSQI quality measures. Most frequently, analyses were based on a single institution setting (19 of 27, 70%), [23][24][25]28,[31][32][33][34][35][36][37][38][39][40][41][42][43]45,49 outcomes were assessed through self-reporting (15 of 27, 56%), 27 …”

“…The populations of interest, and subsequently the study outcomes, were not consistent across all of the studies. There were 2 studies reviewing surgical cases, using complication rates as outcomes (total n ¼ 6066) 23,24 ; 9 studies involving residents with a variety of patient care, resident wellness, and resident education outcomes (total n ¼ 3618) 26,27,[29][30][31][32][33][34][35] ; and 2 studies involving patients with length of stay, mortality, and readmission rates used as outcomes (total n ¼ 4655). 25,28 Of the 2 studies of surgical cases, 1 found no difference in mortality for surgeries performed on shifts shorter than 16 hours compared with shifts longer than 16 hours, but this study found a slightly higher complication rate for procedures performed during shifts longer than 16 hours.…”

“…[23][24][25][26][27][28][29][30][31][32][33][34][35] The length of shifts that were studied ranged from 13 to 36 hours. The populations of interest, and subsequently the study outcomes, were not consistent across all of the studies.…”