Long Working Hour Related Medical Errors and Patient Outcomes among Physicians: A Systematic Review

Authors

  • Wei-Yo Chao School of Medicine, College of Medicine, National Taiwan University,Taiwan (R.O.C.)
  • Shyr-Chyr Chen Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University, College of Medicine,Taipei,Taiwan (R.O.C.)
  • Emma Geerdes School of Medicine, College of Medicine, Erasmus University Rotterdam,The Netherlands
  • Jo-Ching Hsiung School of Medicine, College of Medicine, National Taiwan University,Taiwan (R.O.C.)
  • Cheng-Han Li School of Medicine, College of Medicine, National Taiwan University,Taiwan (R.O.C.)
  • Chien-Chang Lee Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University, College of Medicine,Taipei,Taiwan (R.O.C.)
  • Haruna Tanoue School of Medicine, College of Medicine, Osaka University, Japan

DOI:

https://doi.org/10.17140/EMOJ-4-151

Keywords:

Physicians, Residents, Interns, Duty hours, Working hours, Accreditation council for graduate medical education (ACGME), Complication, Medical error, Adverse events, Patient Safety

Abstract

Aim
Inspired by the famous Libby Zion case in 1984, which revealed the underlying flaw in the medical system at the time──the exploitation of junior medical staff and the inadequate surveillance by attending physicians, authors of this systemic review aim to investigate the potential consequence of overworking in medical scenarios.
Methods
Excerpta medica database (EMBASE) and PubMed had been systematically searched, bibliographies of relevant studies additionally reviewed. Four cohorts and three randomized controlled trials were selected and quality-assessed with Newcastle-Ottawa Scale and the Cochrane risk of bias tool, respectively. Literature were extracted and discussed.
Results
Two randomized controlled trials have concluded that residents or interns with longer consecutive working hours per shift in the division of internal medicine are prone to more medical errors. One cohort study has shown a significant association between longer weekly working hours and worsened quality of patient care (intensive care unit (ICU) transfer rates and in-hospital mortality) in the setting of internal medicine. However, none of the 3 studies which were conducted in surgical departments suggests a further restriction on weekly working hours or shift length.
Conclusion
The specialty-specific policy is recommended based on our between-study comparison. Specifically, with respect to the incidence of medical errors or adverse events, weekly hours or shift length are weakly recommended to be regulated in the department of internal medicine, but there is no recommendation to surgical departments. However, one must consider all respects of the impact brought by any alternation of working policy before the actual implementation.

References

Grober ED, Bohnen JM. Defining medical error. Can J Surg. 2005; 48(1): 39-44.

Arnedt JT, Owens J, Crouch M, Stahl J, Carskadon MA. Neu-robehavioral performance of residents after heavy night call vs after alcohol ingestion. JAMA. 2005; 294(9): 1025-1033. doi: 10.1001/jama.294.9.1025

Lockley SW, Cronin JW, Evans EE, et al. Effect of reducing in-terns’ weekly work hours on sleep and attentional failures. N Engl J Med. 2004; 351(18): 1829-1837. doi: 10.1056/NEJMoa041404

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analy-ses: The PRISMA statement. Ann Intern Med. 2009; 151(4): 264- 269. doi: 10.1136/bmj.b2535

Critical Appraisal Skills Programme (CASP). 2015. Critical ap-praisal skills programme (CASP). Web site. http://www.casp-uk. net/. Accessed January 11, 2015.

Ouyang D, Chen JH, Krishnan G, Hom J, Witteles R, Chi J. Patient outcomes when housestaff exceed 80 hours per week. Am J Med. 2016; 129(9): 993-999. doi: 10.1016/j.amjmed.2016.03.023

Anderson JE, Goodman LF, Jensen GW, Salcedo ES, Galante JM. Restrictions on surgical resident shift length does not impact type of medical errors. J Surg Res. 2017; 212: 8-14. doi: 10.1016/j. jss.2016.12.038

Yaghoubian A, Kaji AH, Ishaque B, et al. Acute care surgery performed by sleep deprived residents: Are outcomes affected?. J Surg Res. 2010; 163(2): 192-196. doi: 10.1016/j.jss.2010.04.011

Bhavsar J, Montgomery D, Li J, et al. Impact of duty hours re-strictions on quality of care and clinical outcomes. Am J Med. 2007; 120(11): 968-974. doi: 10.1016/j.amjmed.2007.07.026 et al 33

Cappuccio FP, Bakewell A, Taggart FM, et al. Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety: Assessor-blind pilot comparison. QJM. 2009; 102(4): 271-282. doi: 10.1093/qjmed/hcp004

Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of re-ducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004; 351(18): 1838-1848. doi: 10.1056/ NEJMoa041406

Bilimoria KY, Chung JW, Hedges LV, et al. National cluster-randomized trial of duty hour flexibility in surgical training. N Engl J Med. 2016; 374(8): 713-727. doi: 10.1056/NEJMoa1515724

Fletcher KE, Davis SQ, Underwood W, Mangrulkar RS, Mc-Mahon LF, Saint S. Systematic review: Effects of resident work hours on patient safety. Ann Intern Med. 2004; 141(11): 851-857. doi: 10.7326/0003-4819-141-11-200412070-00009

Qureshi AU, Ali AS, Hafeez A, Ahmad TM. The effect of con-secutive extended duty hours on the cognitive and behavioural per-formance of paediatric medicine residents. J Pak Med Assoc. 2010; 60(8): 644-649.

Gohar A, Adams A, Gertner E, et al. Working memory capac-ity is decreased in sleep-deprived internal medicine residents. J Clin Sleep Med. 2009; 5(3): 191-197.

Denson J, McCarty M, Fang Y, Uppal A, Evans L. Increased mortality rates during resident handoff periods and the effect of ACGME duty hour regulation. Chest. 2014; 146(4): 338A. doi: 10.1378/chest.2058935

O’Leary KJ, Turner J, Christensen N, Ma M, Lee J, Williams MV, Hansen LO. The effect of hospitalist discontinuity on adverse events. J Hosp Med. 2015; 10(3): 147-151. doi: 10.1002/jhm.2308 34 Chao W-Y

Gonzalo J, Kuperman E, Chuang CH, Lehman EB, Abendroth TW. Impact of an overnight internal medicine academic hospitalist program on patient outcomes. J Gen Intern Med. 2015; 30(12): 1795- 1802. doi: 10.1007/s11606-015-3389-0

Mustahsan SM, Ali SM, Khalid F, et al. Sleep deprivation and its consequences on house officers and postgraduate trainees. J Pak Med Assoc. 2013; 63(4): 540-543.

Maltese F, Adda M, Bablon A, et al. Night shift decreases cog-nitive performance of ICU physicians. Intensive Care Med. 2016; 42(3): 393-400. doi: 10.1007/s00134-015-4115-4

Landrigan CP, Barger LK, Cade BE, Ayas NT, Czeisler CA. In-terns’ compliance with accreditation council for graduate medical education work-hour limits. JAMA. 2006; 296(9): 1063-1070. doi: 10.1001/jama.296.9.1063

Naylor RA, Rege RV, Valentine RJ. Do resident duty hour restrictions reduce technical complications of emergency laparo-scopic cholecystectomy?. J Am Coll Surg. 2005; 201(5): 724-731. doi: 10.1016/j.jamcollsurg.2005.06.271

Gander P, Millar M, Webster C, Merry A. Sleep loss and perfor-mance of anaesthesia trainees and specialists. Chronobiol Int. 2008; 25(6): 1077-1091. doi: 10.1080/07420520802551428

Amirian I, Andersen LT, Rosenberg J, Gogenur I. Working night shifts affects surgeons’ biological rhythm. Am J Surg. 2015; 210(2): 389-395. doi: 10.1016/j.amjsurg.2014.09.035

Amirian I, Andersen LT, Rosenberg J, Gogenur I. Laparoscop-ic skills and cognitive function are not affected in surgeons dur-ing a night shift. J Surg Educ. 2014; 71(4): 543-550.

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Published

2019-01-08

How to Cite

Wei-Yo Chao, Shyr-Chyr Chen, Emma Geerdes, Jo-Ching Hsiung, Cheng-Han Li, Chien-Chang Lee, & Haruna Tanoue. (2019). Long Working Hour Related Medical Errors and Patient Outcomes among Physicians: A Systematic Review. Emergency Medicine, 4(1), 25–35. https://doi.org/10.17140/EMOJ-4-151

Issue

Vol. 4 No. 1 (2018): Volume 4 Issue 1 2018

Section

Articles

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