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Medical residents in hospitals are often required to be on duty for long hours. In 2003 the organization overseeing graduate medical education adopted common program requirements to restrict resident workweeks, including limits to an average of 80 hours over 4 weeks and the longest consecutive period of work to 30 hours in order to protect patients and residents from unsafe conditions resulting from excessive fatigue. Resident Duty Hours provides a timely examination of how those requirements were implemented and their impact on safety, education, and the training institutions. An in-depth review of the evidence on sleep and human performance indicated a need to increase opportunities for sleep during residency training to prevent acute and chronic sleep deprivation and minimize the risk of fatigue-related errors. In addition to recommending opportunities for on-duty sleep during long duty periods and breaks for sleep of appropriate lengths between work periods, the committee also recommends enhancements of supervision, appropriate workload, and changes in the work environment to improve conditions for safety and learning.All residents, medical educators, those involved with academic training institutions, specialty societies, professional groups, and consumer/patient safety organizations will find this book useful to advocate for an improved culture of safety.
Cheryl Ulmer, Dianne Miller Wolman, Michael M.E. Johns, Editors, Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedule to Improve Patient Safety, National Research Council
1 Front Matter; 2 Abstract; 3 Summary; 4 1 Background and Overview; 5 2 Current Duty Hours and Monitoring Adherence; 6 3 Adapting the Resident Educational and Work Environment to Duty Hour Limits; 7 4 Improving the Resident Learning Environment; 8 5 Impact of Duty Hours on Resident Well-Being; 9 6 Contributors to Error in the Training Environment; 10 7 Strategies to Reduce Fatigue Risk in Resident Work Schedules; 11 8 System Strategies to Improve Patient Safety and Error Prevention; 12 9 Resources to Implement Improvements for Patient Safety and Resident Training; 13 Appendix A Statement of Task; 14 Appendix B Comparison of Select Scheduling Possibilities Under Committee Recommendations and Under 2003 ACGME Duty Hour Rules; 15 Appendix C International Experiences Limiting Resident Duty Hours; 16 Appendix D Glossary, Acronyms, and Abbreviations; 17 Appendix E Committee Member Biographies; 18 Appendix F Public Meeting Agendas; 19 Index
National Research Council, Division of Behavioral and Social Sciences and Education, Institute of Medicine, and Families Board on Children, Youth, Steve Olson
Institute of Medicine, Board on the Health of Select Populations, and Transgender Health Issues and Research Gaps and Opportunities Committee on Lesbian, Gay, Bisexual
Institute of Medicine, Board on Population Health and Public Health Practice, Division of Health Promotion and Disease Prevention, Division of International Health
Institute of Medicine, Committee to Develop Methods Useful to the Department of Veteran Affairs in Estimating Its Physician Requirements, Joseph Lipscomb
Institute of Medicine, Board on Health Care Services, Committee on Future Directions for the National Healthcare Quality and Disparities Reports, Sheila Burke, Michelle Bruno, Cheryl Ulmer
Institute of Medicine, Division of Health Care Services, Committee on Medicare Payment Methodology for Clinical Laboratory Services, Lauren LeRoy, Andrea L. Kalfoglou, Dianne Miller Wolman
Institute of Medicine, Board on Health Care Services, Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Earl Steinberg, Sheldon Greenfield, Dianne Miller Wolman, Michelle Mancher, Robin Graham
Institute of Medicine, Board on Health Care Services, Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans, Cheryl Ulmer, Bernadette McFadden, Cassandra Cacace
Institute of Medicine, Board on Health Care Services, Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans, Shadia Bel Hamdounia, Elizabeth McGlynn, John Ball, Cheryl Ulmer
Institute of Medicine, Board on Health Care Services, Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality Improvement, David R. Nerenz, Bernadette McFadden, Cheryl Ulmer