Resident Duty Hours : Enhancing Sleep, Supervision, and Safety

by Ulmer, Cheryl

• ISBN13: 9780309127769
• ISBN10: 0309127769
• Edition: 1st
• Format: Hardcover
• Copyright: 2009-05-01
• Publisher: Natl Academy Pr

Summary

Medical residents in hospitals are often required to be on duty for long hours. In 2003, the organization overseeing graduate medical education adopted common program requirements to restrict resident workweeks, including limits to an average of 80 hours over 4 weeks and the longest consecutive period of work to 30 hours in order to protect patients and residents from unsafe conditions resulting from excessive fatigue.

Table of Contents

Abstract	p. 1
Summary	p. 5
Background and Overview	p. 27
Charge to Committee	p. 29
Graduate Medical Training	p. 30
Duty Hour Demands in the Medical Profession	p. 34
Scope and Organization of Report	p. 36
References	p. 42
Current Duty Hours and Monitoring Adherence	p. 47
Setting Duty Hour Limits	p. 48
Adapting to 2003 Duty Hours	p. 55
Duty Hours in Selected Industries	p. 65
Monitoring Duty Hours	p. 69
References	p. 83
Adapting the Resident Educational and Work Environment to Duty Hour Limits	p. 89
Resident Educational and Work Systems	p. 90
Redesigning Resident Work and Workload	p. 101
Changes in Response to Duty Hour Limits	p. 105
Costs of Adapting to the 2003 Duty Hour Limits	p. 114
References	p. 115
Improving the Resident Learning Environment	p. 125
Educational Principles	p. 126
Impact of 2003 Limits on Educational Outcomes	p. 141
Redesigning Education and Educational Innovations	p. 145
Conclusion	p. 149
References	p. 150
Impact of Duty Hours on Resident Well-Being	p. 159
Resident Safety	p. 160
Resident Well-Being and Quality of Life	p. 165
Conclusion	p. 174
References	p. 175
Contributors to Error in the Training Environment	p. 179
Measuring Hospital-Based Error Rates and Resident Involvement	p. 180
Fatigue as a Contributory to Error	p. 188
Impact of Reduced Duty Hours on Error Rates and Patient Safety	p. 193
Other Contributors to Error	p. 205
Summary	p. 209
References	p. 211
Strategies to Reduce Fatigue Risk In Resident Work Schedules	p. 217
Fatigue, Work Hours, and Sleep Loss	p. 218
Need for Sleep	p. 219
Effects of Acute Sleep Deprivation on Human Performance	p. 222
Acute Sleep Deprivation and Resident Performance	p. 223
Acute Sleep Loss Plus Inexperience in First-Year Residents,	p. 225
Work Duration and Risk	p. 225
Prevention of Acute Sleep Deprivation	p. 227
Improving Adherence to Use of Protected Sleep Periods	p. 231
Prevention of Chronic Sleep Deprivation	p. 232
Approaches to Prevent Chronic Sleep Loss	p. 234
Recovery Sleep	p. 237
Adjustments to the 2003 Resident Duty Hour Limits	p. 241
Additional Considerations Underpinning Recommendation 7-1	p. 243
Resident Moonlighting	p. 251
References	p. 252
System Strategies to Improve Patient Safety and Error Prevention	p. 263
Learning in a Culture of Safety	p. 264
Reducing Errors by Improving Handovers	p. 266
Handover Interventions	p. 269
Training Doctors and Error Reporting	p. 277
Developing a Team Culture	p. 282
Conclusion	p. 286
References	p. 287
Resources to Implement Improvements for Patient Safety and Resident Training	p. 295
Cost Implications of Changes to Duty Hours	p. 298
Funding the Committee's Recommendations	p. 315
Workforce Implications	p. 318
A Phased Implementation of Duty Hours, Its Evaluation, and Further Research	p. 320
References	p. 325
Appendixes	p. 329
Statement of Task	p. 329
Comparison of Select Scheduling Possibilities Under Committee Recommendations and Under 2003 ACGME Duty Hour Rules	p. 331
International Experiences Limiting Resident Duty Hours	p. 339
Glossary, Acronyms, and Abbreviations	p. 363
Committee Member Biographies	p. 371
Public Meeting Agendas	p. 379
Index	p. 385
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