Systematic review: Effects of resident work hours on patient safety
Systematic review: Effects of resident work hours on patient safety
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DOI：
10.7326/0003-4819-141-11-200412070-00009
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发表时间：
2004-12-07
影响因子：
39.2
通讯作者：
Saint, S
中科院分区：
文献类型：
--
作者：
Fletcher, KE;Davis, SQ;Saint, S
背景：研究生医学教育认证委员会 (ACGME) 于 2003 年 7 月对所有住院医师项目制定了新的工作时间规则。目的：严格评估遵守 ACGME 标准将改善患者安全的证据。数据来源：搜索电子数据库（MEDLINE、EMBASE、PREMEDLINE 和 Current Content）以及其他方法来识别 1966 年至 1966 年住院医师工作时间研究的英文文献。 2004.研究选择：评估旨在抵消工作时间、疲劳或睡眠不足影响的系统变革的研究，其中包括与患者安全相关的结果。七项研究符合这些标准。 数据提取：两名研究人员使用标准数据提取表格从所有纳入的研究中提取数据；每项研究均根据既定标准进行评级，以评估研究设计质量。数据综合：使用的干预措施包括浮动系统、其他交叉覆盖系统或未指定的时间表变更。结果包括死亡率、不良事件和用药错误。结果表明，引入此类干预措施对选定的患者安全指标的影响尚不清楚。具体来说，一些指标（例如死亡率）在干预后可能不会改变，而其他指标可能会改善或恶化。 局限性：该分析受到纳入研究的研究设计、研究中干预措施的多样性以及发表偏倚的可能性的限制，这些研究有利于表现出统计显着差异的研究。结论：关于患者安全的证据不足以为减少住院医师工作时间的过程提供信息。
Background: The Accreditation Council for Graduate Medical Education (ACGME) mandated new work hours rules for all residency programs in July 2003.Purpose: To critically evaluate the evidence that adhering to the ACGME standards will improve patient safety.Data Sources: Searches of electronic databases (MEDLINE, EMBASE, PREMEDLINE, and Current Contents) and other methods to identify the English-language literature for studies on resident work hours for the years 1966 to 2004.Study Selection: Studies that assessed a system change designed to counteract the effects of work hours, fatigue, or sleep deprivation and that included an outcome related to patient safety were included. Seven studies met these criteria.Data Extraction: Two investigators abstracted data from all included studies by using a standard data abstraction form; each study was rated according to established criteria to assess study design quality.Data Synthesis: Interventions used were float systems, other cross-coverage systems, or unspecified schedule changes. Outcomes included mortality, adverse events, and medication errors. The results suggest that introducing such interventions has an unclear effect on selected patient safety indicators. Specifically, some indicators (such as mortality) may not change after interventions, while other indicators may improve or worsen.Limitations: This analysis is limited by the study designs of the included studies, the diversity of interventions in the studies, and the possibility of publication bias favoring studies that demonstrated statistically significant differences.Conclusion: Evidence on patient safety is insufficient to inform the process of reducing resident work hours.