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Studies and Analyses
Resident Work-Hour Limits: Minimal Impact on Patient Care Quality
Research was conducted on a convenience sample of 156 residents from three surgical specialties who completed questionnaires designed to measure subjective impressions about the quality of patient care. The sample consisted of residents who were already regulated by work-hour restriction (maximum 80-hour work week) and residents who had not previously been regulated by work-hour restriction.
With a 94.5 percent response rate, more than 88 percent of residents reported that the quality of patient care remained unchanged (63 percent) or was worse (26 percent) after work-hour restrictions had been implemented. This response was particularly true from those residents who had not previously been regulated by work-hour restrictions. Overall, residents reported fewer fatigue-related errors following implementation of work-hour restrictions. However, more errors were perceived to be related to continuity of care, miscommunication and cross-coverage availability.
“The bad news is that a single change to relieve long work schedules of surgical house officers in order to improve quality apparently has 'failed,'” says senior author, Dr. Eavey, Director of Pediatric Otolaryngology at the Massachusetts Eye and Ear Infirmary. “Those same, well-rested house officers perceive that patient care quality unfortunately did not improve. The good news is that the survey has revealed realistic targets for future quality improvement: continuity, cross-coverage and communication – the 'C' factors.”
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