Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units
Christopher P. Landrigan, M.D., M.P.H., Jeffrey M. Rothschild, M.D., M.P.H., John W. Cronin, M.D., Rainu Kaushal, M.D., M.P.H., Elisabeth Burdick, M.S., Joel T. Katz, M.D., Craig M. Lilly, M.D., Peter H. Stone, M.D., Steven W. Lockley, Ph.D., David W. Bates, M.D., Charles A. Czeisler, Ph.D., M.D., for the Harvard Work Hours, Health and Safety Group
Background Although sleep deprivation has been shown to impairneurobehavioral performance, few studies have measured its effectson medical errors.
Methods We conducted a prospective, randomized study comparingthe rates of serious medical errors made by interns while theywere working according to a traditional schedule with extended(24 hours or more) work shifts every other shift (an "everythird night" call schedule) and while they were working accordingto an intervention schedule that eliminated extended work shiftsand reduced the number of hours worked per week. Incidents wereidentified by means of a multidisciplinary, four-pronged approachthat included direct, continuous observation. Two physicianswho were unaware of the interns' schedule assignments independentlyrated each incident.
Results During a total of 2203 patient-days involving 634 admissions,interns made 35.9 percent more serious medical errors duringthe traditional schedule than during the intervention schedule(136.0 vs. 100.1 per 1000 patient-days, P<0.001), including56.6 percent more nonintercepted serious errors (P<0.001).The total rate of serious errors on the critical care unitswas 22.0 percent higher during the traditional schedule thanduring the intervention schedule (193.2 vs. 158.4 per 1000 patient-days,P<0.001). Interns made 20.8 percent more serious medicationerrors during the traditional schedule than during the interventionschedule (99.7 vs. 82.5 per 1000 patient-days, P=0.03). Internsalso made 5.6 times as many serious diagnostic errors duringthe traditional schedule as during the intervention schedule(18.6 vs. 3.3 per 1000 patient-days, P<0.001).
Conclusions Interns made substantially more serious medicalerrors when they worked frequent shifts of 24 hours or morethan when they worked shorter shifts. Eliminating extended workshifts and reducing the number of hours interns work per weekcan reduce serious medical errors in the intensive care unit.
Source Information
From the Divisions of Sleep Medicine (C.P.L., J.W.C., S.W.L., C.A.C.), General Internal Medicine (J.M.R., R.K., E.B., D.W.B.), Infectious Disease (J.T.K.), Pulmonary and Critical Care Medicine (J.W.C., C.M.L.), and Cardiology (P.H.S.) and the Internal Medicine Residency Program (J.T.K.), Department of Medicine, Brigham and Women's Hospital; the Division of Sleep Medicine, Harvard Medical School (C.P.L., J.W.C., S.W.L., C.A.C.); and the Division of General Pediatrics, Department of Medicine, Children's Hospital Boston and Harvard Medical School (C.P.L.) — all in Boston.
Address reprint requests to Dr. Landrigan at the Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Ave., Boston, MA 02115, or at clandrigan{at}rics.bwh.harvard.edu.
Interns' Work Hours
Pennell N. A., Liu J. F., Mazzini M. J., Harnik I. G., Fessler H. E., Brotman D. J., Dwyer J. P., Cohen M. D., Evans A. T., Landrigan C. P., Lockley S. W., Czeisler C. A., the Harvard Work Hours, Health, and Safety Group
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N Engl J Med 2005;
352:726-728, Feb 17, 2005.
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