12/11/2022 0 Comments Report file again a medical resident11 Our analyses compare trends in resident physician-reported medical errors between the two cohorts. During the transition period resident physician work-hour changes were being made nationwide in response to the IOM report (findings first made public in 2008), 10 and a 2010 ACGME report reaffirmed many of the IOM conclusions and established a target date of 1 July 2011 for implementation of the new policies, with exceptions for programmes that needed one or more additional years to make the transition. 21 Data were not available for transition years (2008–2013). We carried out nationwide prospective cohort studies of resident physicians for 5 academic years (2002–2007) before and for 3 academic years (2014–2017) after implementation of the 16 hours 2011 ACGME work-hour limit. Therefore, we undertook an evaluation to determine whether resident physician-reported patient safety outcomes changed following implementation of the 16 hours 2011 ACGME work-hour limit. 18–20 The impact of the 16 hours 2011 ACGME work-hour limit on patient safety outcomes directly reported by resident physicians has not been studied. REPORT FILE AGAIN A MEDICAL RESIDENT PLUS16–18 In light of these studies and opposition to the work-hour limit from within the medical community, the ACGME lifted the 16-hour limit as of 1 July 2017, again allowing first-year resident physicians to be scheduled for 24 hours of continuous work, plus up to 4 hours for care transitions (28 hours 2017 ACGME work-hour limit).Ī limitation of several studies that informed this latest policy change is that the primary end points lacked sensitivity (eg, hospital-wide mortality) or were only tangentially related to the care provided by first-year resident physicians (eg, evaluating the impact of the 16 hours work-hour limit for first-year surgical residents using the outcome of fatal or serious complications after surgical procedures within institutions where first-year surgical residents have a minimal role in surgical procedures). Several studies of the 16 hours 2011 ACGME work-hour limit found that it had no impact on hospital-level mortality or mortality following surgical procedures. 14 In addition, the work-hour limitations were not accompanied by an increased number of residency slots, leading to work compression and a shift in some responsibilities to other clinical providers, 15 as well as concerns about resident physician understaffing. 13 The increased frequency of patient handoffs raised concerns, as physician-to-physician handoffs have historically been non-standardised and prone to error. 12 Many stakeholders expected the changes to diminish the educational experience. The response within the medical community to the 16 hours 2011 ACGME work-hour limit was mixed. 9 10 In response, the ACGME issued new work-hour regulations on 1 July 2011, limiting first-year resident physicians to a maximum of 16 consecutive work hours and emphasising a commitment to patient safety and mitigation of fatigue-related risks (16 hours 2011 ACGME work-hour limit). 8 Subsequently, the Institute of Medicine of the National Academies (IOM) reviewed the available evidence and concluded that it was unsafe for any resident physician to provide clinical care for >16 consecutive hours without sleep. 6 7 Altogether, a body of evidence accumulated suggesting that reducing or eliminating shifts longer than 16 hours did not negatively impact resident education and likely improved patient safety and resident quality of life. REPORT FILE AGAIN A MEDICAL RESIDENT TRIAL5 A randomised controlled trial found that limiting first-year resident physicians to 16 consecutive work hours significantly improved resident alertness and patient safety. 2 Subsequent evaluations found that shifts of 24 or more hours were associated with increased odds of fatigue-related medical errors and preventable adverse events (PAEs), 3 percutaneous injuries 4 and motor vehicle crashes. 1 From 2003 to 2011, the Accreditation Council for Graduate Medical Education (ACGME) limited residents in their first postgraduate year to a maximum of 30 consecutive work hours, including 6 hours for continuity of care and educational activities (30 hours 2003 ACGME work-hour limit). Resident physicians’ work hours have been a subject of controversy in the USA for more than two decades.
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