Skip to main content
Top
Published in: Patient Safety in Surgery 1/2012

Open Access 01-12-2012 | Letter to the Editor

Resident work hour restrictions do not improve patient safety in surgery: a critical appraisal based on 7 years of experience in Switzerland

Authors: Adrian P Businger, Urban Laffer, Reto Kaderli

Published in: Patient Safety in Surgery | Issue 1/2012

Login to get access

Abstract

In 2005 the Swiss government implemented new work-hour limitations for all residency programs in Switzerland, including a 50-hour weekly limit. The reduction in the working hours of doctors in training implicate an increase in their rest time and suggest an amelioration of doctors' clinical performance and consequently in patients' outcomes and safety - which was not detectable in a preliminary study at a large referral center in Switzerland. It remains elusive why work-hour restrictions did not improve patient safety. We are well advised to thoroughly examine and eliminate the known adverse effects of reduced work-hours to improve our patients' safety.
Literature
1.
go back to reference Weinger MB, Ancoli-Israel S: Sleep deprivation and clinical performance. JAMA. 2002, 287: 955-957. 10.1001/jama.287.8.955.CrossRefPubMed Weinger MB, Ancoli-Israel S: Sleep deprivation and clinical performance. JAMA. 2002, 287: 955-957. 10.1001/jama.287.8.955.CrossRefPubMed
2.
go back to reference Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J: Laparoscopic performance after one night on call in a surgical department: prospective study. BMJ. 2001, 323: 1222-1223.PubMedCentralCrossRefPubMed Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J: Laparoscopic performance after one night on call in a surgical department: prospective study. BMJ. 2001, 323: 1222-1223.PubMedCentralCrossRefPubMed
3.
go back to reference Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA: Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004, 351: 1838-1848. 10.1056/NEJMoa041406.CrossRefPubMed Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA: Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004, 351: 1838-1848. 10.1056/NEJMoa041406.CrossRefPubMed
4.
go back to reference Report of the New York State Department of Health Ad Hoc Advisory Committee on Emergency Services: Supervision and residents’ working conditions. 1987, New York: New York State Department of Health Report of the New York State Department of Health Ad Hoc Advisory Committee on Emergency Services: Supervision and residents’ working conditions. 1987, New York: New York State Department of Health
6.
go back to reference Iglehart JK: Revisiting duty-hour limits--IOM recommendations for patient safety and resident education. N Engl J Med 2008. 2008, 359: 2633-263. Iglehart JK: Revisiting duty-hour limits--IOM recommendations for patient safety and resident education. N Engl J Med 2008. 2008, 359: 2633-263.
8.
go back to reference Businger A, Guller U, Oertli D: Effect of the 50-hour workweek limitation on training of surgical residents in Switzerland. Arch Surg. 2010, 145: 558-563. 10.1001/archsurg.2010.88.CrossRefPubMed Businger A, Guller U, Oertli D: Effect of the 50-hour workweek limitation on training of surgical residents in Switzerland. Arch Surg. 2010, 145: 558-563. 10.1001/archsurg.2010.88.CrossRefPubMed
9.
go back to reference Mache S, Kelm R, Bauer H, Nienhaus A, Klapp BF, Groneberg DA: General and visceral surgery practice in German hospitals: a real-time work analysis on surgeons’ work flow. Langenbecks Arch Surg. 2010, 395: 81-87. 10.1007/s00423-009-0541-5.CrossRefPubMed Mache S, Kelm R, Bauer H, Nienhaus A, Klapp BF, Groneberg DA: General and visceral surgery practice in German hospitals: a real-time work analysis on surgeons’ work flow. Langenbecks Arch Surg. 2010, 395: 81-87. 10.1007/s00423-009-0541-5.CrossRefPubMed
10.
go back to reference Pape HC, Pfeifer R: Restricted duty hours for surgeons and impact on residents quality of life, education, and patient care: a literature review. Patient Saf Surg. 2009, 3: 3-10.1186/1754-9493-3-3.PubMedCentralCrossRefPubMed Pape HC, Pfeifer R: Restricted duty hours for surgeons and impact on residents quality of life, education, and patient care: a literature review. Patient Saf Surg. 2009, 3: 3-10.1186/1754-9493-3-3.PubMedCentralCrossRefPubMed
11.
go back to reference Fletcher KE, Underwood W, Davis SQ, Mangrulkar RS, McMahon LF, Saint S: Effects of work hour reduction on residents' lives: a systematic review. JAMA. 2005, 294: 1088-1100. 10.1001/jama.294.9.1088.CrossRefPubMed Fletcher KE, Underwood W, Davis SQ, Mangrulkar RS, McMahon LF, Saint S: Effects of work hour reduction on residents' lives: a systematic review. JAMA. 2005, 294: 1088-1100. 10.1001/jama.294.9.1088.CrossRefPubMed
12.
go back to reference Moonesinghe SR, Lowery J, Shahi N, Millen A, Beard JD: Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review. BMJ. 2011, 342: d1580-10.1136/bmj.d1580.CrossRefPubMed Moonesinghe SR, Lowery J, Shahi N, Millen A, Beard JD: Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review. BMJ. 2011, 342: d1580-10.1136/bmj.d1580.CrossRefPubMed
13.
go back to reference Jamal MH, Doi SA, Rousseau M, Edwards M, Rao C, Barendregt JJ, Snell L, Meterissian S: Systematic review and meta-analysis of the effect of North American working hours restrictions on mortality and morbidity in surgical patients. Br J Surg. 2012, 99: 336-344. 10.1002/bjs.8657. Epub 2012 Jan 12.CrossRefPubMed Jamal MH, Doi SA, Rousseau M, Edwards M, Rao C, Barendregt JJ, Snell L, Meterissian S: Systematic review and meta-analysis of the effect of North American working hours restrictions on mortality and morbidity in surgical patients. Br J Surg. 2012, 99: 336-344. 10.1002/bjs.8657. Epub 2012 Jan 12.CrossRefPubMed
14.
go back to reference Nuckols TK, Bhattacharya J, Wolman DM, Ulmer C, Escarce JJ: Cost implications of reduced work hours and workloads for resident physicians. N Engl J Med. 2009, 360: 2202-2215. 10.1056/NEJMsa0810251.CrossRefPubMed Nuckols TK, Bhattacharya J, Wolman DM, Ulmer C, Escarce JJ: Cost implications of reduced work hours and workloads for resident physicians. N Engl J Med. 2009, 360: 2202-2215. 10.1056/NEJMsa0810251.CrossRefPubMed
15.
go back to reference Oakely JE, Clewer GJ, Cool WP, Ford DJ: The effect of the EWTD on orthopaedic specialist training. Ann R Coll Surg Engl (Supp). 2005, 87: 320-321.CrossRef Oakely JE, Clewer GJ, Cool WP, Ford DJ: The effect of the EWTD on orthopaedic specialist training. Ann R Coll Surg Engl (Supp). 2005, 87: 320-321.CrossRef
16.
go back to reference Cappuccio FP, Bakewell A, Taggart FM, Ward G, Ji C, Sullivan JP, Edmunds M, Pounder R, Landrigan CP, Lockley SW, Peile E: Warwick EWTD Working Group: Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety: assessor-blind pilot comparison. QJM. 2009, 102: 271-282. 10.1093/qjmed/hcp004.PubMedCentralCrossRefPubMed Cappuccio FP, Bakewell A, Taggart FM, Ward G, Ji C, Sullivan JP, Edmunds M, Pounder R, Landrigan CP, Lockley SW, Peile E: Warwick EWTD Working Group: Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety: assessor-blind pilot comparison. QJM. 2009, 102: 271-282. 10.1093/qjmed/hcp004.PubMedCentralCrossRefPubMed
17.
go back to reference Collum J, Harrop J, Stokes M, Kendall D: Patient safety and quality of care continue to improve in NHS North West following early implementation of the European Working Time Directive. QJM. 2010, 103: 929-940. 10.1093/qjmed/hcq139.PubMedCentralCrossRefPubMed Collum J, Harrop J, Stokes M, Kendall D: Patient safety and quality of care continue to improve in NHS North West following early implementation of the European Working Time Directive. QJM. 2010, 103: 929-940. 10.1093/qjmed/hcq139.PubMedCentralCrossRefPubMed
18.
go back to reference Kaderli R, Businger A, Stefenelli U, Laffer U: Morbidity in surgery: impact of the 50-hour work-week limitation in Switzerland. Swiss Med Wkly. 2012, 142: 10.4414/smw.2012.13506. Kaderli R, Businger A, Stefenelli U, Laffer U: Morbidity in surgery: impact of the 50-hour work-week limitation in Switzerland. Swiss Med Wkly. 2012, 142: 10.4414/smw.2012.13506.
Metadata
Title
Resident work hour restrictions do not improve patient safety in surgery: a critical appraisal based on 7 years of experience in Switzerland
Authors
Adrian P Businger
Urban Laffer
Reto Kaderli
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Patient Safety in Surgery / Issue 1/2012
Electronic ISSN: 1754-9493
DOI
https://doi.org/10.1186/1754-9493-6-17

Other articles of this Issue 1/2012

Patient Safety in Surgery 1/2012 Go to the issue