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Impact of resident duty hour limits on safety in the intensive care unit: A national survey of pediatric and neonatal intensivists*

Typpo, Katri V. MD, MPH; Tcharmtchi, M. Hossein MD; Thomas, Eric J. MD, MPH; Kelly, P. Adam PhD; Castillo, Leticia D. MD; Singh, Hardeep MD, MPH

Pediatric Critical Care Medicine: September 2012 - Volume 13 - Issue 5 - p 578–582
doi: 10.1097/PCC.0b013e318241785c
Quality and Safety
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Objective: Resident duty-hour regulations potentially shift the workload from resident to attending physicians. We sought to understand how current or future regulatory changes might impact safety in academic pediatric and neonatal intensive care units.

Design: Web-based survey.

Setting: U.S. academic pediatric and neonatal intensive care units.

Subjects: Attending pediatric and neonatal intensivists.

Interventions: We evaluated perceptions on four intensive care unit safety-related risk measures potentially affected by current duty-hour regulations: 1) attending physician and resident fatigue; 2) attending physician workload; 3) errors (self-reported rates by attending physicians or perceived resident error rates); and 4) safety culture. We also evaluated perceptions of how these risks would change with further duty-hour restrictions.

Measurements and Main Results: We administered our survey between February and April 2010 to 688 eligible physicians, of whom 360 (52.3%) responded. Most believed that resident error rates were unchanged or worse (91.9%) and safety culture was unchanged or worse (84.4%) with current duty-hour regulations. Of respondents, 61.9% believed their own work-hours providing direct patient care increased and 55.8% believed they were more fatigued while providing direct patient care. Most (85.3%) perceived no increase in their own error rates currently, but in the scenario of further reduction in resident duty-hours, over half (53.3%) believed that safety culture would worsen and a significant proportion (40.3%) believed that their own error rates would increase.

Conclusions: Pediatric intensivists do not perceive improved patient safety from current resident duty-hour restrictions. Policies to further restrict resident duty-hours should consider unintended consequences of worsening certain aspects of intensive care unit safety.

From the Houston VA HSR&D Center of Excellence (KVT, HS), Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX; the University of Arizona, Health Sciences Center and the Steele Children’s Research Center (KVT), Department of Pediatrics, Section of Critical Care Medicine, Tucson, AZ; Baylor College of Medicine (MHT), Department of Pediatrics, Section of Critical Care Medicine, Houston, TX; the University of Texas at Houston–Memorial Herman Center for Healthcare Quality and Safety and the Division of General Medicine (EJT), Department of Medicine, University of Texas Medical School at Houston, Houston, TX; Tulane University School of Medicine (PAK), Department of Medicine, New Orleans, LA; and the University of Texas, Southwestern (LDC), Department of Pediatrics, Section of Pediatric Critical Care Medicine, Dallas, TX.

*See also p. 602.

This work was partially supported by a National Institutes of Health K23 career development award (K23CA125585) and in part by the Houston VA HSR&D Center of Excellence (HFP90[hyphen]020) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Improving the Safety and Quality of Pediatric Health Care (1K24HD053771).

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The authors have not disclosed any potential conflicts of interest.

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©2012The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies