ContextThe Accreditation Council for Graduate Medical Education implemented
mandatory work hour limitations in July 2003, partly out of concern for residents’
well-being in the setting of sleep deprivation. These limitations are likely
to also have an impact on other aspects of the lives of residents.ObjectiveTo summarize the literature regarding the effect of interventions to
reduce resident work hours on residents’ education and quality of life.Data SourcesWe searched the English-language literature about resident work hours
from 1966 through April 2005 using MEDLINE, EMBASE, and Current Contents,
supplemented with hand-search of additional journals, reference list review,
and review of abstracts from national meetings.Study SelectionStudies were included that assessed a system change designed to counteract
the effects of resident work hours, fatigue, or sleep deprivation; included
an outcome directly related to residents; and were conducted in the United
States.Data ExtractionFor each included study, 2 investigators independently abstracted data
related to study quality, subjects, interventions, and findings using a standard
data abstraction form.Data SynthesisFifty-four articles met inclusion criteria. The interventions used to
decrease resident work hours varied but included night and day float teams,
extra cross-coverage, and physician extenders. Outcomes included measures
of resident education (operative experience, test scores, satisfaction) and
quality of residents’ lives (amount of sleep, well-being). Interventions
to reduce resident work hours resulted in mixed effects on both operative
experience and on perceived educational quality but generally improved residents’
quality of life. Many studies had major limitations in their design or conduct.ConclusionsPast interventions suggest that residents’ quality of life may
improve with work hour limitations, but interpretation of the outcomes of
these studies is hampered by suboptimal study design and the use of nonvalidated
instruments. The long-term impact of reducing resident work hours on education
remains unknown. Current and future interventions should be evaluated with
more rigorous methods and should investigate links between residents’
quality of life and quality of patient care.

https://jamanetwork.com/journals/jama/articlepdf/201482/JRV50017.pdf

Effects of Work Hour Reduction on Residents’ Lives: A Systematic Review

Background Transfer of responsibility for patient care between physicians is a key process in the care of hospitalized patients. Systems of transfer management and transfer frequency may affect clinical outcomes. Methods To characterize the systems by which patient information is transferred (“signed out”) between resident physicians in internal medicine residency programs and to determine the impact of recently enacted resident work-hour regulations on the frequency of transfers, we mailed a self-administered survey to chief residents at 324 accredited US internal medicine residency programs outside of New York State. The main outcome measures were sign-out practices, skills training, and transfer frequency. Results Surveys were returned from 202 programs (62%). Transfer systems varied among and within institutions: 55% did not consistently require both a written and an oral sign-out at transfers of care, 34% left sign-out to interns alone, and 59% had no means of informing nurses that a transfer had taken place. In addition, 60% of the programs did not provide any lectures or workshops on sign-out skills. After work-hour regulations were instituted, transfers of care for a hypothetical patient increased by a mean of 11% (from 7.0 to 7.8 transfers; P Conclusion Although transfers of care are increasingly frequent, few internal medicine residency programs have comprehensive transfer of care systems in place, and most do not provide formal training in sign-out skills to all residents.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/410469/ioi60023.pdf

Transfers of patient care between house staff on internal medicine wards: a national survey.

BACKGROUND
Transfer of responsibility for patient care between physicians is a key process in the care of hospitalized patients. Systems of transfer management and transfer frequency may affect clinical outcomes.


METHODS
To characterize the systems by which patient information is transferred ("signed out") between resident physicians in internal medicine residency programs and to determine the impact of recently enacted resident work-hour regulations on the frequency of transfers, we mailed a self-administered survey to chief residents at 324 accredited US internal medicine residency programs outside of New York State. The main outcome measures were sign-out practices, skills training, and transfer frequency.


RESULTS
Surveys were returned from 202 programs (62%). Transfer systems varied among and within institutions: 55% did not consistently require both a written and an oral sign-out at transfers of care, 34% left sign-out to interns alone, and 59% had no means of informing nurses that a transfer had taken place. In addition, 60% of the programs did not provide any lectures or workshops on sign-out skills. After work-hour regulations were instituted, transfers of care for a hypothetical patient increased by a mean of 11% (from 7.0 to 7.8 transfers; P<.001) during a Monday-Friday hospitalization. A member of the primary team was in the hospital for 47% of the hospitalization.


CONCLUSION
Although transfers of care are increasingly frequent, few internal medicine residency programs have comprehensive transfer of care systems in place, and most do not provide formal training in sign-out skills to all residents.

Transfers of Patient Care Between House Staff on Internal Medicine Wards

As training programs begin to implement the ACGME's most recent duty-hour rules, it is useful to review evidence supporting the new rules. This systematic review assessed studies on the association...

Systematic Review: Association of Shift Length, Protected Sleep Time, and Night Float With Patient Care, Residents' Health, and Education

Effect of work hours, caseload, shift type, and experience on resident call performance.

The aim of this study is to describe the effects of a new night float system on the circadian rhythm and clinical judgment of our residents. In addition, the study looks at the residents' opinions of how to optimize the night float system in the future. All 20 of the radiology residents at our institution completed a questionnaire about the night float system after completing their night float coverage. The results of the questionnaire were then compiled and tabulated. It took our residents an average of 2.0 days to become acclimated to the night float and an average of 2.3 days to return to a normal daily routine after completing the night float. No residents perceived impairment in their clinical judgment while on the night float. However, 9 of the 20 residents (45%) stated that their clinical judgment was improved on the night float compared to that of a 24-hour call. Eighteen of 20 residents (90%) preferred the night float system to a 24-hour call system. On average, our residents believe that the optimal number of hours for a night float shift is 10.5 hours and the optimal numbers of days to do the night float consecutively is 6.8 days. In conclusion, a night float system can be a preferable means of evening coverage as it has a minimal effect on the circadian rhythm by allowing residents to become acclimated to working the night shift over the course of several days. The night float system also demonstrates no appreciable adverse effects on clinical judgment and may allow better clinical judgment than a 24-hour call system.

The graveyard shift: experience with a night float system.

A 25-year-old man with no significant medical history reported low back pain and had a questionable L5 pars defect on the right. Whole-body scintigraphs and SPECT images of the lumbar spine revealed a solitary lesion manifested as a cold defect involving the right half of the L1 vertebra. Subsequently, magnetic resonance imaging (MRI) of the lumbar spine showed findings suggestive of a vertebral hemangioma, but a computed tomographic (CT) scan of the lumbar spine was recommended for a more definitive diagnosis. The CT scan revealed the characteristic polka-dot appearance of a vertebral hemangioma involving the right half of the L1 vertebral body.

Vertebral hemangioma presenting as a cold defect on bone scintigraphy.

The appendix is the smallest, nonfunctional segment of gastrointestinal tract. Appendicitis is the most common surgical emergency, but the clinical diagnosis often is not straightforward and can be very challenging. Delayed diagnosis can lead to increased morbidity due to such complications as appen

Normal Appendix, Appendicitis, and Complications: CT Evaluation—A Practical Approach and Challenges for Diagnostic Radiologists

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The graveyard shift: experience with a night float system.

Vertebral hemangioma presenting as a cold defect on bone scintigraphy.

Normal Appendix, Appendicitis, and Complications: CT Evaluation—A Practical Approach and Challenges for Diagnostic Radiologists