Shorter hospital shifts reduce errors and improve patient outcomes
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《英国医生杂志》
Two new studies confirm what many junior doctors have long known—that shortening the length of on-call shifts improves doctors?performance, and in turn, patient outcomes.
In the first study Dr Steven Lockley of the division of sleep medicine at the Brigham and Women's Hospital, Boston, and Harvard Medical School, found that interns slept more and performed better when they were part of rotations specifically designed to give them more time to sleep during their shifts (New England Journal of Medicine 2004;351:1829-37).
The researchers studied 20 interns during their two three-week rotations in intensive care units. Each intern was observed during a traditional rotation schedule that included extended work shifts of 30 consecutive hours scheduled every other night and a special schedule in which work shifts were a maximum of 16 consecutive hours.
The interns completed daily sleep logs that were validated with regular weekly episodes (72 to 96 hours) of continuous polysomnography (monitoring of the body抯 activities during sleep) (r=0.94) and work logs that were validated by means of direct observation by study staff (r=0.98).
Seventeen of 20 interns worked more than 80 (mean 84.9; range 74.2-92.1) hours a week during the traditional schedule. All interns worked fewer than 80 (65.4; 57.6-76.3) hours a week during the intervention schedule. On average, compared with interns on the traditional schedule, interns on the intervention schedule worked 19.5 hours a week less (P<0.001), slept 5.8 hours a week more (P<0.001), slept more in the 24 hours preceding each working hour (P<0.001), and had less than half the rate of failures of attention while working during on-call nights (P=0.02).
In the second study, researchers found that interns made a substantially higher number of serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts (New England Journal of Medicine 2004;351:1838-48).
In their randomised crossover study of rates of serious medical errors made by interns, Dr Christopher Landrigan of the division of sleep medicine at the Brigham and Women's Hospital and Harvard Medical School and colleagues compared rates when doctors worked a traditional schedule with extended (24 hours or more) work shifts every other shift (an 揺very third night?call schedule) with rates when they worked an intervention schedule that eliminated extended work shifts and reduced the number of hours worked each week.
During a total of 2203 patient days involving 634 admissions, the rate of serious medical errors was 35.9% higher when interns worked the traditional schedule than when they worked the intervention schedule (136.0 v 100.1 per 1000 patient days; P<0.001), including an increase of 56.6% in the number of serious errors that were not intercepted (P<0.001). The total rate of serious errors on the critical care units was 22.0% higher during the traditional schedule than during the intervention schedule (193.2 v 158.4 per 1000 patient days; P<0.001).
The rate of serious medication errors was 20.8% higher during the traditional schedule than during the intervention schedule (99.7 v 82.5 per 1000 patient days; P=0.03), and the rate of serious diagnostic errors was also higher (5.6 times higher) (18.6 v 3.3 per 1000 patient days; P<0.001).(New York Scott Gottlieb)
In the first study Dr Steven Lockley of the division of sleep medicine at the Brigham and Women's Hospital, Boston, and Harvard Medical School, found that interns slept more and performed better when they were part of rotations specifically designed to give them more time to sleep during their shifts (New England Journal of Medicine 2004;351:1829-37).
The researchers studied 20 interns during their two three-week rotations in intensive care units. Each intern was observed during a traditional rotation schedule that included extended work shifts of 30 consecutive hours scheduled every other night and a special schedule in which work shifts were a maximum of 16 consecutive hours.
The interns completed daily sleep logs that were validated with regular weekly episodes (72 to 96 hours) of continuous polysomnography (monitoring of the body抯 activities during sleep) (r=0.94) and work logs that were validated by means of direct observation by study staff (r=0.98).
Seventeen of 20 interns worked more than 80 (mean 84.9; range 74.2-92.1) hours a week during the traditional schedule. All interns worked fewer than 80 (65.4; 57.6-76.3) hours a week during the intervention schedule. On average, compared with interns on the traditional schedule, interns on the intervention schedule worked 19.5 hours a week less (P<0.001), slept 5.8 hours a week more (P<0.001), slept more in the 24 hours preceding each working hour (P<0.001), and had less than half the rate of failures of attention while working during on-call nights (P=0.02).
In the second study, researchers found that interns made a substantially higher number of serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts (New England Journal of Medicine 2004;351:1838-48).
In their randomised crossover study of rates of serious medical errors made by interns, Dr Christopher Landrigan of the division of sleep medicine at the Brigham and Women's Hospital and Harvard Medical School and colleagues compared rates when doctors worked a traditional schedule with extended (24 hours or more) work shifts every other shift (an 揺very third night?call schedule) with rates when they worked an intervention schedule that eliminated extended work shifts and reduced the number of hours worked each week.
During a total of 2203 patient days involving 634 admissions, the rate of serious medical errors was 35.9% higher when interns worked the traditional schedule than when they worked the intervention schedule (136.0 v 100.1 per 1000 patient days; P<0.001), including an increase of 56.6% in the number of serious errors that were not intercepted (P<0.001). The total rate of serious errors on the critical care units was 22.0% higher during the traditional schedule than during the intervention schedule (193.2 v 158.4 per 1000 patient days; P<0.001).
The rate of serious medication errors was 20.8% higher during the traditional schedule than during the intervention schedule (99.7 v 82.5 per 1000 patient days; P=0.03), and the rate of serious diagnostic errors was also higher (5.6 times higher) (18.6 v 3.3 per 1000 patient days; P<0.001).(New York Scott Gottlieb)