Background
Resident duty hour limitations aim, in part, to reduce medical errors. Residents’ perceptions of the impact of duty hours on errors are unknown.
Objective
To determine residents’ self-reported contributing factors, frequency, and impact of hours worked on suboptimal care practices and medical errors.
Design
Cross-sectional survey.
Subjects
164 Internal Medicine Residents at the University of California, San Francisco.
Measurements and Results
Residents were asked to report the frequency and contributing factors of suboptimal care practices and medical errors, and how duty hours impacted these practices and aspects of resident work-life. One hundred twenty-five residents (76%) responded. The most common suboptimal care practices were working while impaired by fatigue and forgetting to transmit information during sign-out. In multivariable models, residents who felt overwhelmed with work (p = 0.02) and who reported spending >50% of their time in nonphysician tasks (p = 0.002) were more likely to report suboptimal care practices. Residents reported work-stress (a composite of fatigue, excessive workload, distractions, stress, and inadequate time) as the most frequent contributing factor to medical errors. In multivariable models, only engaging in suboptimal practices was associated with self-report of higher risk for medical errors (p < 0.001); working more than 80 hours per week was not associated with suboptimal care or errors.
Conclusion
Our findings suggest that administrative load and work stressors are more closely associated with resident reports of medical errors than the number of hours work. Efforts to reduce resident duty hours may also need to address the nature of residents’ work to reduce errors.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Philibert I, Friedmann P, Williams WT. New requirements for resident duty hours. JAMA. 2002;288(9):1112–4.
Nuckols TK, Escarce JJ. Residency work-hours reform. A cost analysis including preventable adverse events. J Gen Intern Med. 2005;20(10):873–8.
Accreditation Council of Graduate Medical Education. http://www.acgme.com. Last accessed 9/05.
Health Care Cost and Utilization Project. 2004, Agency for Healthcare Quality and Research. http://hcup.ahrq.gov/HCUPNet.asp. Last assessed 9/05.
Laine, C, Goldman, L, Soukop, JR, Hayes, JG. The impact of a regulation restricting medical house staff working hours on the quality of patient care. JAMA. 1993;269(3):374–8.
Howard D, Silber J, Jobes D. Do regulations limiting residents’s work hours affect patient mortality? J Gen Intern Med. 2004;19:1–7.
Fletcher KE, Underwood W III, Davis SQ, Mangrulkar RS, McMahon LF Jr., Saint S. Systematic review: effects of resident work hours on patient safety. Ann Intern Med. 2004;141(11):851–7.
Vidyarthi AR, Katz PP, Wall SD, Wachter RM, Auerbach AD. Impact of reduced duty hours on resident’s educational satisfaction at the University of California, San Francisco. Acad Med. 2006;81(1):76–82.
Lurie N, Rank B, Parenti C, Woolley T, Snoke W. How do house officers spend their nights? A time study of internal medicine house staff on call. N Engl J Med. 1989;320(25):1673–77.
Gottlieb DJ, Parenti CM, Peterson CA, Lofgren RP. Effect of a change in house staff work schedule on resource utilization and patient care. Arch Intern Med. 1991;151(10):2065–70.
Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136(5):358–67.
Wu AW, Folkman S, PcPhee SJ, Lo B. Do house officers learn from their mistakes? JAMA. 1991;265(16):2089–94.
Lockley SW, Cronin JW, Evans EE, et al. Effect of reducing interns’s weekly work hours on sleep and attentional failures. N Engl J Med. 2004;351(18):1829–37.
Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351(18):1838–48.
Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994;121(11):866–72.
Volpp KGM, Grande D. Residents’ suggestions for reducing errors in teaching hospitals. N Engl J Med. 2003;348(9):851–5.
Drazen JM. Awake and informed. N Engl J Med. 2004;351(18):1884.
Solet DJ, Norvell JM, Rutan GH, Frankel RM. Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med. 2005;80(12):1094–9.
Scher KS, Peoples JB. A study of the on-duty hours of surgical residents. Surgery. 1990;108(2):393–9.
Dresselhaus TR, Luck J, Wright BC, Spragg RG, Lee ML, Bozzette SA. Analyzing the time and value of housestaff inpatient work. J Gen Intern Med. 1998;13(8):534–40.
Kort KC, Pavone LA, Jensen E, Haque E, Newman N, Kittur D. Resident perceptions of the impact of work-hour restrictions on health care delivery and surgical education: Time for transformational change. Surgery. 2004;136(4):861–71.
Dellit TH, Armas-Loughran B, Bosl GH, Sepkowitz KA, Thaler H, Blaskovich J. A method for assessing house staff workload as a function of length of stay. JAMA. 2001;286(9):1023–24.
Collier VU, McCue JD, Markus A, Smith L. Stress in medical residency: Status quo after a decade of reform? Ann Intern Med. 2002;136(5):384–90.
Fletcher KE, Underwood W III, Davis SQ, Mangrulkar RS, McMahon LF Jr., Saint S. Effects of work hour reduction on residents’ lives: a systematic review. JAMA. 2005;294(9):1088–100.
Baldwin DC Jr., Daugherty SR. Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents. Sleep. 2004;27(2):217–23.
Buff DD, Shabti R. The night float system of resident on call: what do the nurses think? J Gen Intern Med. 1995;10(7):400–2.
Carey JC, Fishburne JI. A method to limit working hours and reduce sleep deprivation in an obstetrics and gynecology residency program. Obstet Gynecol. 1989;74(4):668–72.
Lieu TA, Forrest CB, Blum NJ, Cornfeld, Polin RA. Effects of a night-float system on resident activities and parent satisfaction. Am J Dis Child. 1992;146(3):307–10.
Moore SS, Nettleman MD, Beyer S, et al. How residents spend their nights on call. Acad Med. 2000;75(10):1021–4.
Acknowledgements
We gratefully acknowledge the following for their assistance in conception and compilation of this study: Marla Eisenberg, ScD, David Irby, PhD., and Erin Hartman, MS. Dr. Vidyarthi had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Potential Financial Conflicts of Interests
None Disclosed.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vidyarthi, A.R., Auerbach, A.D., Wachter, R.M. et al. The Impact of Duty Hours on Resident Self Reports of Errors. J GEN INTERN MED 22, 205–209 (2007). https://doi.org/10.1007/s11606-006-0065-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-006-0065-4