Systematic Review of the Impact of Physician Work Schedules on Patient Safety with Meta-Analyses of Mortality Risk

Details

• Personal Author:
  Barger LK ; Landrigan CP ; Sullivan JP ; Weaver MD
• Description:
  Resident physician work hour limits continue to be controversial. Numerous trials have come to conflicting conclusions about the impact on patient safety of eliminating extended duration work shifts. We conducted meta-analyses to evaluate the impact of work hour policies and work schedules on patient safety. After identifying 8,362 potentially relevant studies and reviewing 688 full-text articles, 132 studies were retained and graded on quality of evidence. Of these, 68 studies provided enough information for consideration in meta-analyses. We found that patient safety improved following implementation of the Accreditation Council for Graduate Medical Education's 2003 and 2011 resident physicians work hour guidelines. Limiting all resident physicians to 80-hour work weeks and 28-hour shifts in 2003 was associated with an 11% reduction in mortality (p < 0.001). Limited shift durations and shorter work weeks were also associated with improved patient safety in clinical trials and observational studies not specifically tied to policy changes. Given the preponderance of evidence showing that patient and physician safety is negatively affected by long work hours, efforts to improve physician schedules should be prioritized. Policies that enable extended-duration shifts and long work weeks should be reexamined. Further research should expand beyond resident physicians to additional study populations, including attending physicians and other health care workers. [Description provided by NIOSH]
• Subjects:
  Health Personnel Mortality Occupational Health Safety Shift Work Schedule
• Keywords:
  Long Work Hours Mortality Rates Physicians Policy Shift Work Systematic Reviews Work Schedules
• ISSN:
  1553-7250
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Massachusetts ; OSHA Region 1
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  49
• Issue:
  11
• NIOSHTIC Number:
  nn:20069736
• Citation:
  Jt Comm J Qual Patient Saf 2023 Nov; 49(11):634-647
• Email:
  lkbarger@hms.harvard.edu
• Federal Fiscal Year:
  2024
• Performing Organization:
  Brigham and Women's Hospital, Boston, Massachusetts
• Peer Reviewed:
  True
• Start Date:
  20190901
• Source Full Name:
  Joint Commission Journal on Quality and Patient Safety
• End Date:
  20230831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:eac34421c921e1a1d716e840041c1f3f3be7e8555ff9780275838ccfa23fbb45a7bb78022a09094ea3c7543a14d781e7322f96a370d79163c25c1336f06a3eff
• Download URL:
  https://stacks.cdc.gov/view/cdc/208098/cdc_208098_DS1.pdf
• File Type:
  [PDF - 2.27 MB ]