Key Scientific Studies

In recent years a body of scientific evidence has begun to mount calling into question the safety of long work hours for both patients and resident physicians. Below is a listing of the key academic findings on the topic of resident work hours published in recent years. Click on the citation for a more detailed abstract of the study or to download a full text version of the article.

Recent studies have found that on-call shifts of 24 consecutive hours or more:

• increased the incidence of preventable medical errors sevenfold (Public Library of Science Medicine, 2006);
• increased the risk residents faced of needle sticks and other accidental percutaneous injuries that expose them to potentially harmful bodily fluid by 61 percent (Journal of the American Medical Association, 2006);
• led to decreased performance on tests of response and vigilance (Sleep, 2005);
• more than doubled the likelihood residents would get into a motor vehicle accident on the after-work commute (New England Journal of Medicine, 2005);
• led to performance impairments similar to subjects in a control group with a 0.05% blood alcohol level (Journal of the American Medical Association, 2005);
• caused medical interns to be twice as likely to suffer attentional failures at night and 35.9 percent more likely to commit a serious medical error (New England Journal of Medicine, 2004).

Other important findings include:

• most medical interns’ schedules violate the ACGME resident work hour regulations in some way (Journal of the American Medical Association, 2006);
• shorter hours have improved patient care in several key areas (Annals of Internal Medicine, 2007);
• in VA hospitals, stricter hour limits were associated with improved mortality rates for patients with 4 common medical conditions (Journal of the American Medical Association, 2007);
• tighter work hour regulations were associated with decreased mortality among high-risk patients (Annals of Internal Medicine, 2007).
  

Also of note in the academic literature:

• the federal Agency for Health Research and Quality (AHRQ) recommended that hospitals “limit shifts of more than 24 hours for medical residents” in their 2006 publication 10 Patient Safety Tips for Hospitals (AHRQ, 2006);
• Ingrid Philibert, the ACGME’s Director of Field Activities, acknowledged the likelihood that “residents may experience significant performance decrements under the current minimum [ACGME work hour] standards” in a meta-analysis of 60 previous studies of the effects of sleep deprivation (Sleep, 2005);
• In reviewing their research on the effects of fatigue on residents, Harvard sleep researchers conclude that “residency programs routinely make evidence-based decisions in clinical practice and even in selecting trainees, but have appeared reluctant to rely on such data to develop safe resident work hour schedules” (Clinical Orthopaedics & Related Research, 2006).
• Australian researchers Drew Dawson and Kathryn Reid found that being awake for 24 hours produced cognitive psychomotor deterioration equivalent to a 0.1% blood alcohol level (Dawson D, Reid K. “Fatigue, alcohol and performance impairment.” Nature, 1997;88:235).