A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes.
A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes.
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DOI：
10.1097/sla.0000000000000595
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发表时间：
2014-06
影响因子：
9
通讯作者：
Rutka J
中科院分区：
文献类型：
--
作者：
Ahmed N;Devitt KS;Keshet I;Spicer J;Imrie K;Feldman L;Cools-Lartigue J;Kayssi A;Lipsman N;Elmi M;Kulkarni AV;Parshuram C;Mainprize T;Warren RJ;Fata P;Gorman MS;Feinberg S;Rutka J
进行了系统回顾和荟萃分析，以评估住院医师值班时间（RDH）对手术临床和教育结果的影响。共有 135 篇文章符合纳入标准。在外科手术中，近期 RDH 的变化并不总是与住院医师健康状况的改善相关，并且可能对患者的治疗结果和教育产生负面影响。 2003 年，研究生医学教育认证委员会 (ACGME) 规定住院医师值班时间不得超过 80 小时。 2011 年，ACGME 规定 PGY1（研究生年）住院医师最多工作 16 小时。既定目标是改善患者安全、居民福祉和教育。进行了系统回顾和荟萃分析，以评估住院医师值班时间（RDH）对手术临床和教育结果的影响。在 CINAHL、Cochrane 数据库、Embase、Medline 和 Scopus 上进行了系统评价（1980-2013）。使用 GRADE 指南评估文章质量。十六小时轮班和夜间浮动系统分别进行了分析。检查死亡率数据的文章被合并到随机效应荟萃分析中，以评估 RDH 对患者死亡率的影响。共有135篇文章符合纳入标准。其中，42% (N = 57) 被认为是中高质量。 RDH 并未显着改善患者的预后；然而，一些研究表明，高危患者的并发症发生率会增加。与 RDH 限制相关的教育没有改善，某些专业的认证考试成绩有所下降。调查研究揭示了人们对教育和患者安全恶化的看法。每周工作 80 小时后，居民的健康状况有所改善，但在实施 16 小时最长工作时间后，居民的健康状况几乎没有改善或产生负面影响。最近的 RDH 变化并不总是与居民福祉的改善相关，并且对患者的治疗结果和认证考试的表现产生负面影响。需要更大的灵活性来满足住院医师培训需求。应非常谨慎地考虑训练时间的进一步减少。
A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. A total of 135 articles met inclusion criteria. In surgery, recent RDH changes are not consistently associated with improved resident well-being and may have negative impacts on patient outcomes and education. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. A systematic review (1980–2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution.