Association for Surgical EducationThe effect of a rotating night-float coverage scheme on preventable and potentially preventable morbidity at a level 1 trauma center
Section snippets
Data collection
The Institutional Review Board of East Carolina University, Brody School of Medicine approved the design and conduct of this study. All 2826 patients admitted to East Carolina University’s level 1 trauma service between November 2001 and August 2003 were eligible for inclusion and were reviewed. Demographic, Injury Severity Score (ISS), length of hospital stay, length of intensive care unit (ICU) stay, ventilator days, mortality, and complication data were prospectively collected for 11 months
Results
After institution of this coverage scheme, resident work hours were successfully decreased from an estimated 100 to 105 hours per week to a mean of 78.4 hours per week. There was no significant difference in demographic profiles between the 2 study periods. The number of admissions, mean ISS, length of hospital stay, length of ICU stay, ventilator days, and overall mortality were also similar before and after institution of our rotating night-float system. These data are presented in Table 1.
Comments
The recent policy change by the Accreditation Council for Graduate Medical Education restricting resident work hours was in large part because of public concern regarding patient safety. Medical errors and their potential association with prolonged resident work hours are frequently reported in the lay press. Therefore, it is intuitive for the general public to assume that limiting resident work hours is an easy way to decrease the medical errors associated with patient injury and death [16].
Conclusion
Although additional study is warranted to fully delineate the effect of resident work-hour restriction on attending workload, resident scholarship, technical performance, and preparedness for practice, these areas were not addressed in our investigation. In our system, resident work-hour restrictions did not improve or worsen the occurrence of overall complications or change the distribution of those determined to be preventable or potentially preventable. These findings support the belief that
References (24)
- et al.
Effect of sleep deprivation on the performance of simulated laparoscopic surgical skill
Am J Surg
(2003) - et al.
Effects of limited work hours on surgical training
J Am Coll Surg
(2002) - et al.
Work hours reformperceptions and desires of contemporary surgical residents
J Am Coll Surg
(2003) Limits imposed on residents’ work hours
Lancet
(2003)- Gurgala A, Lurie P, Haroon L, et al. Petition to the Occupational Safety and Health Administration requesting that...
- United States House of Representatives Resolution (HR # 3236) [Patient and Physician Safety and Protection Act],...
- et al.
The intern and sleep loss
N Engl J Med
(1971) - et al.
Sleep deprivation and cognitive testing in internal medicine housestaff
West J Med
(1990) - et al.
Sleep deprivation and clinical performance
JAMA
(2002)
Implementing resident work hour limitations, lessons from the New York State experience
Ann Surg
The impact of a regulation restricting medical house staff working hours on the quality of patient care
JAMA
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2016, Journal of Surgical EducationCitation Excerpt :Furthermore, senior residents lost significant operative experience while operating under an NF system as compared with the traditional rotating call schedule.15,16 With respect to patient safety, 1 study found that mortality after implementation of the NF coverage was unchanged.17 The traditional residency structure was redesigned by the Department of Surgery at Northwestern University Feinberg School of Medicine in Chicago with the aim of including a mixture of apprenticeship, small-team, and NF models.18
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