Abstract
BackgroundA recent randomized controlled trial in critical-care units revealed that the elimination of extended-duration work shifts (≥24 h) reduces the rates of significant medical errors and polysomnographically recorded attentional failures. This raised the concern that the extended-duration shifts commonly worked by interns may contribute to the risk of medical errors being made, and perhaps to the risk of adverse events more generally. Our current study assessed whether extended-duration shifts worked by interns are associated with significant medical errors, adverse events, and attentional failures in a diverse population of interns across the United States.Methods and FindingsWe conducted a Web-based survey, across the United States, in which 2,737 residents in their first postgraduate year (interns) completed 17,003 monthly reports. The association between the number of extended-duration shifts worked in the month and the reporting of significant medical errors, preventable adverse events, and attentional failures was assessed using a case-crossover analysis in which each intern acted as his/her own control. Compared to months in which no extended-duration shifts were worked, during months in which between one and four extended-duration shifts and five or more extended-duration shifts were worked, the odds ratios of reporting at least one fatigue-related significant medical error were 3.5 (95% confidence interval [CI], 3.3–3.7) and 7.5 (95% CI, 7.2–7.8), respectively. The respective odds ratios for fatigue-related preventable adverse events, 8.7 (95% CI, 3.4–22) and 7.0 (95% CI, 4.3–11), were also increased. Interns working five or more extended-duration shifts per month reported more attentional failures during lectures, rounds, and clinical activities, including surgery and reported 300% more fatigue-related preventable adverse events resulting in a fatality.ConclusionsIn our survey, extended-duration work shifts were associated with an increased risk of significant medical errors, adverse events, and attentional failures in interns across the United States. These results have important public policy implications for postgraduate medical education.
Highlights
The Accreditation Council for Graduate Medical Education (ACGME) has recently placed limitations on resident work hours in an attempt to reduce fatigue-related medical errors, the practice of working for more than 24 h consecutively remains the cornerstone of American postgraduate medical education
Our current study assessed whether extended-duration shifts worked by interns are associated with significant medical errors, adverse events, and attentional failures in a diverse population of interns across the United States
In our survey, extended-duration work shifts were associated with an increased risk of significant medical errors, adverse events, and attentional failures in interns across the United States
Summary
The Accreditation Council for Graduate Medical Education (ACGME) has recently placed limitations on resident work hours in an attempt to reduce fatigue-related medical errors, the practice of working for more than 24 h consecutively remains the cornerstone of American postgraduate medical education. A recent randomized trial reported that interns working extended-duration shifts (defined as at least 24 h continuously at work) had significantly more polysomnographically recorded attentional failures and made significantly more serious medical errors than those scheduled to work shifts 16 h or longer [2,3]. A recent randomized controlled trial in critical-care units revealed that the elimination of extended-duration work shifts (24 h) reduces the rates of significant medical errors and polysomnographically recorded attentional failures. This raised the concern that the extendedduration shifts commonly worked by interns may contribute to the risk of medical errors being made, and perhaps to the risk of adverse events more generally. A total of 2,737 interns took part in the survey
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