Reduced Work Hours for ICU Staff for Patient Safety

减少 ICU 工作人员的工作时间以确保患者安全

• 批准号: 7010528
• 负责人: Christopher Paul Landrigan
• 金额: $ 29.99万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-01 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7010528
• 关键词: behavioral /social science research tag; clinical research; cooperative study; fatigue; functional ability; health care personnel performance; health care policy; health care service evaluation; health care service planning; health service demonstration project; health services research tag; human subject; intensive care; occupational psychology; patient safety /medical error; psychic activity level; psychomotor function; sleep deprivation; statistics /biometry

DESCRIPTION (provided by the applicant): Medical error is a leading cause of death in the United States. Sleep deprivation has been proven to significantly impair performance and increase the risk of error in industrial settings, but health care has been slow to adopt work hour reforms. Physicians-in-training still routinely work up to 30 hours in a row. We recently found that interns working a traditional schedule in two ICUs made 36 percent more serious medical errors and 5 times as many serious diagnostic errors as interns whose consecutive work was limited to 16 hours. Despite this substantive improvement, however, full implementation of a reduced work schedule has not occurred, even in the units where our intervention proved effective. Barriers to broadly implementing change have included our prior study's focus on interns rather than all house staff, and perceived problems with our initial intervention signout system. To more effectively implement reduced work hours for physicians, while addressing the limitations of our prior intervention study, we propose the following: 1. To implement two new house staff work schedules in a MICU and CCU, which will eliminate extended shifts for all interns, junior residents, and senior residents in these settings; 2. To test the hypothesis that compared with a traditional schedule, house staff sleeps as well as serious medical error rates will improve in a new CCU schedule that eliminates extended shifts for all interns and senior residents, but retains a traditional rounding and house officer staffing structure; 3. To test the hypothesis that house staff sleep and serious medical error rates will likewise improve in a restructured MICU that eliminates extended shifts, but also dramatically alters staffing, sign out, and rounding systems to support shorter work hours, including the initiation of twice-daily team rounds. Our proposed before-after study of two distinct schedule implementation strategies will advance knowledge of how best to reduce work hours while minimizing errors due to care discontinuities. We will determine serious error rates using our established four-pronged detection method that includes direct, continuous observation of house staff by physicians, followed by rigorous review of all incidents. Comparisons before and after implementing each system will yield information needed to develop an effective scheduling tool that can be widely disseminated to reduce physician work hours and improve patient safety nationwide.

描述（由申请人提供）：医疗错误是美国死亡的主要原因。事实证明，睡眠不足会严重损害工作绩效并增加工业环境中出错的风险，但医疗保健部门在工作时间改革方面进展缓慢。实习医生仍然通常连续工作长达 30 个小时。我们最近发现，与连续工作时间限制为 16 小时的实习生相比，在两个 ICU 中按传统时间表工作的实习生所犯的严重医疗错误要高出 36%，严重诊断错误要高出 5 倍。然而，尽管有了这种实质性的改善，即使在我们的干预措施被证明有效的单位中，减少工作时间的情况也没有得到全面实施。广泛实施变革的障碍包括我们之前的研究重点关注实习生而不是所有内部员工，以及我们的初始干预签出系统存在的问题。为了更有效地减少医生的工作时间，同时解决我们之前干预研究的局限性，我们提出以下建议： 1. 在 MICU 和 CCU 中实施两项新的住院人员工作时间表，这将消除这些机构中所有实习生、初级住院医师和高级住院医师的延长轮班； 2. 检验以下假设：与传统时间表相比，在新的 CCU 时间表中，住院工作人员的睡眠时间以及严重医疗错误率将得到改善，该时间表消除了所有实习生和老年住院医生的延长轮班时间，但保留了传统的舍入和住院人员人员配置结构； 3. 检验这样的假设：在重组后的 MICU 中，宿舍工作人员的睡眠和严重医疗错误率同样会得到改善，该 MICU 消除了长时间的轮班，但也极大地改变了人员配置、签出和 支持缩短工作时间的查房制度，包括启动每天两次的团队查房。 我们提出的对两种不同的时间表实施策略的前后研究将增进人们对如何最好地减少工作时间同时最大限度地减少由于护理中断而导致的错误的了解。我们将使用我们既定的四管齐下的检测方法来确定严重错误率，其中包括医生对住院工作人员进行直接、持续的观察，然后对所有事件进行严格审查。实施每个系统之前和之后的比较将产生开发有效的调度工具所需的信息，该工具可以广泛传播，以减少医生的工作时间并提高全国范围内的患者安全。