The Institute of Medicine recommended in 2009 that residents in their first year of training be limited to working sixteen consecutive hours (twelve hour shifts plus four hours for handoffs). This was a change from prior recommendations of thirty hours (twenty four hour shifts plus six hours for handoffs). In July 2011, these recommendations were instituted by the ACGME. The evidence supporting this change is controversial.
Our primary hypothesis was that the new duty hour regulations would reduce medical errors, specifically on pharmacy orders written overnight in the Medical Intensive Care Unit (MICU).
A retrospective study was performed at Rhode Island Hospital, a 720-bed academic medical center with an eighteen bed MICU staffed by residents and fellows 24 hours a day. To address the change in work hours, the MICU implemented a night call system and reduced continuous work hours from thirty hours to sixteen hours. We compared the incidence of errors in computerized physician prescribing during the first eight months of the prior academic year to the eight months after resident shifts were changed, and we assessed the errors by time of day. In order to track the prescribing errors we accessed a pharmacy database which tracks all interventions identified by pharmacists (errors identified prior to the error affecting patient care) dispensing for MICU patients. These interventions are categorized by severity and type of error. We analyzed a total of 5473 prevented prescribing errors prior to duty hour changes and 6142 after the change.
We found that after the reduction in resident hours, there was a significant increase in the rate of prevented prescribing errors at night (11.8% increase in prevented prescribing errors p<0.05). The day shifts showed no significant difference in the rate of prevented errors. The increased number of errors may be a reflection of discontinuity associated with new duty hours. The increase in prescribing errors occurred despite significant efforts that were made to improve hand-offs.
Our study results are not consistent with the assumption that a reduction in work hours improves patient safety.
Rhode Island Hospital and The Miriam Hospital
Rhode Island Hospital
Lifespan, Warren Alpert Medical School, Brown University
Miriam Hospital and Rhode Island Hospital
Miriam Hospital Rhode Island Hospital, Warren Alpert Medical School, Brown University