What Effects Have Resident Work-hour Changes Had on Education, Quality of Life, and Safety? A Systematic Review
What Effects Have Resident Work-hour Changes Had on Education, Quality of Life, and Safety? A Systematic Review
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DOI：
10.1007/s11999-014-3968-0
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发表时间：
2015-05-01
影响因子：
4.2
通讯作者：
McCormick, Frank
中科院分区：
文献类型：
--
作者：
Harris, Joshua D.;Staheli, Greg;McCormick, Frank
15年多前，医学研究所（IOM）将医疗差错确定为一个值得更多关注的问题;在IOM报告发布后，对限制居民值班时间的规定进行了许多修改。然而，在骨科领域，住院医师工作时间变化的影响仍然存在争议。我们进行了一项系统的回顾，以确定工作时间限制是否对生活质量指标、手术和技术技能发展、住院医师外科教育、患者护理结局产生了可测量的影响。（包括死亡率、发病率、不良事件、哨兵事件、并发症）以及外科医生和住院医师的态度（如对学习和培训经验的感知效果、个人受益、直接临床经验、临床准备）。我们对PubMed、Scopus、CINAHL（护理和相关健康文献累积索引）和使用PRISMA（系统性综述和荟萃分析的首选报告项目）指南的Google Scholar。纳入标准为分析骨科住院医师工作时间限制对患者安全、住院医师教育、住院医师/外科医生生活质量、住院医师技术操作技能发展和住院医师对工作时间限制态度的影响的任何英文同行评审文章。11项研究符合研究纳入标准。1项研究为前瞻性分析，10项研究为IV级证据在我们确定的研究中，有一些支持改善住院医师生活质量，改善住院医师睡眠和减少疲劳，对外科手术和技术技能的负面影响，以及住院医师教育，患者结局，对工作时间变化的态度也各不相同。缺乏高水平或明确的证据来评估居民工作时间变化的影响。这一领域的未来研究应侧重于将患者安全作为主要结局的客观措施。
More than 15 years ago, the Institute of Medicine (IOM) identified medical error as a problem worthy of greater attention; in the wake of the IOM report, numerous changes were made to regulations to limit residents' duty hours. However, the effect of resident work-hour changes remains controversial within the field of orthopaedics.We performed a systematic review to determine whether work-hour restrictions have measurably influenced quality-of-life measures, operative and technical skill development, resident surgical education, patient care outcomes (including mortality, morbidity, adverse events, sentinel events, complications), and surgeon and resident attitudes (such as perceived effect on learning and training experiences, personal benefit, direct clinical experience, clinical preparedness).We performed a systematic review of PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were any English language peer-reviewed articles that analyzed the effect(s) of orthopaedic surgery resident work-hour restrictions on patient safety, resident education, resident/surgeon quality of life, resident technical operative skill development, and resident surgeon attitudes toward work-hour restrictions. Eleven studies met study inclusion criteria. One study was a prospective analysis, whereas 10 studies were of level IV evidence (review of surgical case logs) or survey results.Within our identified studies, there was some support for improved resident quality of life, improved resident sleep and less fatigue, a perceived negative impact on surgical operative and technical skill, and conflicting evidence on the topic of resident education, patient outcomes, and variable attitudes toward the work-hour changes.There is a paucity of high-level or clear evidence evaluating the effect of the changes to resident work hours. Future research in this area should focus on objective measures that include patient safety as a primary outcome.