FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 347:1249-1255 October 17, 2002 Number 16 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF PDA Full Text Editorial by Drazen, J. M. Editorial by Leape, L. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Sleep deprivation due to extended work hours and circadian disruption has long been a concern in medicine.¹ It has been called the Achilles' heel of the medical profession.² The levels of continuous duty and work hours for health care personnel are much greater than those allowed in the transportation and nuclear-power industries.^3,4 The problem is most severe for residents in training but extends to experienced physicians and nurses. Clinicians who have been deprived of sleep are part of a health care system in trouble. A report from the Institute of Medicine concludes that the system fails to ensure that patients . . . [Full Text of this Article]

Sleep Deprivation among Residents

Does Fatigue Impair Performance?

Does the System Need to Be Changed?

Reform of Policies on Residents' Work Hours

Reforms in Other Countries

Other Forces for Change

Policy Options for the United States

Limits on Work Hours and On-Call Periods

Managing the Consequences of Limited Work Hours

Changing the Behavior of Clinicians and the Culture of Health Care Organizations

Costs and Benefits of Policy Options

Conclusions

Source Information

From the Patient Safety Center of Inquiry, Veterans Affairs Palo Alto Health Care System, Palo Alto; and the Department of Anesthesia, Stanford University School of Medicine, Stanford — both in California.

Address reprint requests to Dr. Gaba at the Anesthesiology Service, 112A, 3801 Miranda Ave., Palo Alto, CA 94304, or at gaba@stanford.edu.

Related Letters:

Residents' Work Hours
Crausman R. S., Mullins M. D., Mascolo M. C., Watson P. Y., Potee R., Blalock A., Rosen I. M., Shea J. A., Bellini L. M., Steinbrook R.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:664-666, Feb 13, 2003. Correspondence

This article has been cited by other articles:

• Stern, Z., Katz-Navon, T., Naveh, E. (2008). The Influence of Situational Learning Orientation, Autonomy, and Voice on Error Making: The Case of Resident Physicians. Management Science 54: 1553-1564 [Abstract]  
• Langelotz, C., Scharfenberg, M., Haase, O., Schwenk, W. (2008). Stress and Heart Rate Variability in Surgeons During a 24-Hour Shift. Arch Surg 143: 751-755 [Abstract] [Full Text]  
• Bashore, T. M., Wang, A. (2008). Recent Accreditation Council for Graduate Medical Education Initiatives Have Not Been Shown to Improve the Education of Cardiology Fellows. Circulation 118: 532-537 [Full Text]  
• Dracup, K., Morris, P. E. (2008). How Will They Learn?. Am J Crit Care 17: 306-309 [Full Text]  
• Berlin, L. (2008). Liability of the Sleep-Deprived Resident. Am. J. Roentgenol. 190: 845-851 [Full Text]  
• Rasminsky, S., Lomonaco, A., Auchincloss, E. (2008). Work Hours Regulations for House Staff in Psychiatry: Bad or Good for Residency Training?. Acad. Psychiatry 32: 54-60 [Abstract] [Full Text]  
• Parshuram, C. S. MB ChB DPh, To, T. PhD, Seto, W. BScPhm Pha, Trope, A. MSc RPh, Koren, G. MBBS, Laupacis, A. MD MSc (2008). Systematic evaluation of errors occurring during the preparation of intravenous medication. CMAJ 178: 42-48 [Abstract] [Full Text]  
• Gander, P., Purnell, H., Garden, A., Woodward, A. (2007). Work patterns and fatigue-related risk among junior doctors. Occup. Environ. Med. 64: 733-738 [Abstract] [Full Text]  
• Volpp, K. G., Rosen, A. K., Rosenbaum, P. R., Romano, P. S., Even-Shoshan, O., Wang, Y., Bellini, L., Behringer, T., Silber, J. H. (2007). Mortality Among Hospitalized Medicare Beneficiaries in the First 2 Years Following ACGME Resident Duty Hour Reform. JAMA 298: 975-983 [Abstract] [Full Text]  
• Volpp, K. G., Rosen, A. K., Rosenbaum, P. R., Romano, P. S., Even-Shoshan, O., Canamucio, A., Bellini, L., Behringer, T., Silber, J. H. (2007). Mortality Among Patients in VA Hospitals in the First 2 Years Following ACGME Resident Duty Hour Reform. JAMA 298: 984-992 [Abstract] [Full Text]  
• Auerbach, A. D., Landefeld, C. S., Shojania, K. G. (2007). The Tension between Needing to Improve Care and Knowing How to Do It. NEJM 357: 608-613 [Full Text]  
• Salim, A., Teixeira, P. G. R., Chan, L., Oncel, D., Inaba, K., Brown, C., Rhee, P., Berne, T. V. (2007). Impact of the 80-Hour Workweek on Patient Care at a Level I Trauma Center. Arch Surg 142: 708-714 [Abstract] [Full Text]  
• Szeinbach, S., Seoane-Vazquez, E., Parekh, A., Herderick, M. (2007). Dispensing errors in community pharmacy: perceived influence of sociotechnical factors. Int J Qual Health Care 19: 203-209 [Abstract] [Full Text]  
• Jacobs, I A, Podobny, M T, Bilusich, D (2007). One mechanism underlying contrasting health-economy findings. Int J Epidemiol 36: 929-931 [Full Text]  
• Chung, R. S., Ahmed, N. (2007). How Surgical Residents Spend Their Training Time: The Effect of a Goal-Oriented Work Style on Efficiency and Work Satisfaction. Arch Surg 142: 249-252 [Abstract] [Full Text]  
• McDonald, R., Waring, J., Harrison, S. (2006). At the Cutting Edge? Modernization and Nostalgia in a Hospital Operating Theatre Department. Sociology 40: 1097-1115 [Abstract]  
• Reiling, J (2006). Safe design of healthcare facilities. Qual Saf Health Care 15: i34-i40 [Abstract] [Full Text]  
• Schuwirth, L. W T, van der Vleuten, C. P M (2006). Challenges for educationalists.. BMJ 333: 544-546 [Full Text]  
• Landrigan, C. P., Barger, L. K., Cade, B. E., Ayas, N. T., Czeisler, C. A. (2006). Interns' compliance with accreditation council for graduate medical education work-hour limits.. JAMA 296: 1063-1070 [Abstract] [Full Text]  
• West, C. P., Huschka, M. M., Novotny, P. J., Sloan, J. A., Kolars, J. C., Habermann, T. M., Shanafelt, T. D. (2006). Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.. JAMA 296: 1071-1078 [Abstract] [Full Text]  
• Philip, P., Taillard, J., Moore, N., Delord, S., Valtat, C., Sagaspe, P., Bioulac, B. (2006). The effects of coffee and napping on nighttime highway driving: a randomized trial.. ANN INTERN MED 144: 785-791 [Abstract] [Full Text]  
• Abdel-Latif, M. E., Bajuk, B., Oei, J., Lui, K., for the New South Wales and the Australian Capital, (2006). Mortality and Morbidities Among Very Premature Infants Admitted After Hours in an Australian Neonatal Intensive Care Unit Network. Pediatrics 117: 1632-1639 [Abstract] [Full Text]  
• Scott, L. D., Rogers, A. E., Hwang, W.-T., Zhang, Y. (2006). Effects of Critical Care Nurses' Work Hours on Vigilance and Patients' Safety. Am J Crit Care 15: 30-37 [Abstract] [Full Text]  
• Brenner, R. J., Ulissey, M. J., Wilt, R. M. (2006). Computer-Aided Detection as Evidence in the Courtroom: Potential Implications of an Appellate Court's Ruling. Am. J. Roentgenol. 186: 48-51 [Abstract] [Full Text]  
• O'Malley, P. G., Khandekar, J. D., Phillips, R. A. (2005). Residency Training in the Modern Era: The Pipe Dream of Less Time to Learn More, Care Better, and Be More Professional. Arch Intern Med 165: 2561-2562 [Full Text]  
• Goitein, L., Shanafelt, T. D., Wipf, J. E., Slatore, C. G., Back, A. L. (2005). The Effects of Work-Hour Limitations on Resident Well-being, Patient Care, and Education in an Internal Medicine Residency Program. Arch Intern Med 165: 2601-2606 [Abstract] [Full Text]  
• Feddock, C. A., Hoellein, A. R., Griffith, C. H., Wilson, J. F., Becker, N. S., Bowerman, J. L., Caudill, T. S. (2005). Are Continuity Clinic Patients Less Satisfied When Residents Have a Heavy Inpatient Workload?. Eval Health Prof 28: 390-399 [Abstract]  
• Mycyk, M. B., McDaniel, M. R., Fotis, M. A., Regalado, J. (2005). Hospitalwide adverse drug events before and after limiting weekly work hours of medical residents to 80. Am J Health Syst Pharm 62: 1592-1595 [Abstract] [Full Text]  
• Gould, J. B., Qin, C., Chavez, G. (2005). Time of Birth and the Risk of Neonatal Death. Obstet Gynecol 106: 352-358 [Abstract] [Full Text]  
• Leape, L. L., Berwick, D. M. (2005). Five Years After To Err Is Human: What Have We Learned?. JAMA 293: 2384-2390 [Abstract] [Full Text]  
• Amalberti, R., Auroy, Y., Berwick, D., Barach, P. (2005). Five System Barriers to Achieving Ultrasafe Health Care. ANN INTERN MED 142: 756-764 [Abstract] [Full Text]  
• Dracup, K., Bryan-Brown, C. W. (2005). First, Do No Harm. Am J Crit Care 14: 99-101 [Full Text]  
• Fletcher, K. E., Davis, S. Q., Underwood, W., Mangrulkar, R. S., McMahon, L. F. Jr., Saint, S. (2004). Systematic Review: Effects of Resident Work Hours on Patient Safety. ANN INTERN MED 141: 851-857 [Abstract] [Full Text]  
• Lockley, S. W., Cronin, J. W., Evans, E. E., Cade, B. E., Lee, C. J., Landrigan, C. P., Rothschild, J. M., Katz, J. T., Lilly, C. M., Stone, P. H., Aeschbach, D., Czeisler, C. A., the Harvard Work Hours, Health and Safety Group, (2004). Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures. NEJM 351: 1829-1837 [Abstract] [Full Text]  
• Landrigan, C. P., Rothschild, J. M., Cronin, J. W., Kaushal, R., Burdick, E., Katz, J. T., Lilly, C. M., Stone, P. H., Lockley, S. W., Bates, D. W., Czeisler, C. A., the Harvard Work Hours, Health and Safety Group, (2004). Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units. NEJM 351: 1838-1848 [Abstract] [Full Text]  
• Croskerry, P., Campbell, S. (2004). Canadian Adverse Events Study. CMAJ 171: 833-833 [Full Text]  
• Parshuram, C. S. (2004). Preparing physicians for the real world. CMAJ 171: 709-709 [Full Text]  
• Howard, S. K. (2004). Preparing physicians for the real world. CMAJ 171: 709-710 [Full Text]  
• Sargent, M. C., Sotile, W., Sotile, M. O., Rubash, H., Barrack, R. L. (2004). Stress and Coping Among Orthopaedic Surgery Residents and Faculty. JBJS 86: 1579-1586 [Abstract] [Full Text]  
• Rogers, A. E., Hwang, W.-T., Scott, L. D., Aiken, L. H., Dinges, D. F. (2004). The Working Hours Of Hospital Staff Nurses And Patient Safety. Health Aff (Millwood) 23: 202-212 [Abstract] [Full Text]  
• Jones, M. D. Jr. (2004). More Than a Matter of Time. Pediatrics 113: 1396-1398 [Full Text]  
• Parshuram, C. S., Dhanani, S., Kirsh, J. A., Cox, P. N. (2004). Fellowship training, workload, fatigue and physical stress: a prospective observational study. CMAJ 170: 965-970 [Abstract] [Full Text]  
• Howard, S. K., Gaba, D. M. (2004). Trainee fatigue: Are new limits on work hours enough?. CMAJ 170: 975-976 [Full Text]  
• Crawford, F. A. Jr (2003). Presidential address: thoracic surgery education--responding to a changing environment. J. Thorac. Cardiovasc. Surg. 126: 1235-1242 [Full Text]  
• Berwick, D. M. (2003). Errors Today and Errors Tomorrow. NEJM 348: 2570-2572 [Full Text]  
• Brennan, T. A., Zinner, M. J. (2003). Residents' work hours: a wake up call?. Int J Qual Health Care 15: 107-108 [Full Text]  
• Klazinga, N., van Bolderen, A. (2003). Epimetheus' responsibility: resident working hours and system redesign. Int J Qual Health Care 15: 109-110 [Full Text]  
• Volpp, K. G.M., Grande, D. (2003). Residents' Suggestions for Reducing Errors in Teaching Hospitals. NEJM 348: 851-855 [Full Text]  
• Crausman, R. S., Mullins, M. D., Mascolo, M. C., Watson, P. Y., Potee, R., Blalock, A., Rosen, I. M., Shea, J. A., Bellini, L. M., Steinbrook, R. (2003). Residents' Work Hours. NEJM 348: 664-666 [Full Text]  
• Rivkees, S. A. (2003). Time to Wake-Up to the Individual Variation in Sleep Needs. J. Clin. Endocrinol. Metab. 88: 24-25 [Full Text]  
• Philibert, I., Barach, P. (2002). Residents' hours of work. BMJ 325: 1184-1185 [Full Text]  
• Drazen, J. M., Epstein, A. M. (2002). Rethinking Medical Training -- The Critical Work Ahead. NEJM 347: 1271-1272 [Full Text]  
• Leape, L., Epstein, A. M., Hamel, M. B. (2002). A Series on Patient Safety. NEJM 347: 1272-1274 [Full Text]  
• Steinbrook, R. (2002). The Debate over Residents' Work Hours. NEJM 347: 1296-1302 [Full Text]