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Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes

In 2017, interns were permitted to work continuously for up to 28 hours at a time, a reversal from the previously mandated 16-hour limit. Our objective was to evaluate perceptions of care and patient outcomes on an extended (28-hour) compared with a limited (16-hour) duty-hour system on identical in...

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Autores principales: Salgado, Sanjay M., Katz, Joel T., Pelletier, Stephen R., Goodberlet, Melanie, Kelly, Julie, Duperreault, Megan, Ali, Nadaa B., Shields, Helen M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9422754/
https://www.ncbi.nlm.nih.gov/pubmed/35152234
http://dx.doi.org/10.1097/PTS.0000000000000988
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author Salgado, Sanjay M.
Katz, Joel T.
Pelletier, Stephen R.
Goodberlet, Melanie
Kelly, Julie
Duperreault, Megan
Ali, Nadaa B.
Shields, Helen M.
author_facet Salgado, Sanjay M.
Katz, Joel T.
Pelletier, Stephen R.
Goodberlet, Melanie
Kelly, Julie
Duperreault, Megan
Ali, Nadaa B.
Shields, Helen M.
author_sort Salgado, Sanjay M.
collection PubMed
description In 2017, interns were permitted to work continuously for up to 28 hours at a time, a reversal from the previously mandated 16-hour limit. Our objective was to evaluate perceptions of care and patient outcomes on an extended (28-hour) compared with a limited (16-hour) duty-hour system on identical interdisciplinary teams. METHODS: Sixty-two interns, 27 residents, 28 attendings, and 449 patients participated. Patients completed surveys assessing their satisfaction. Anonymous weekly surveys were obtained from interns, residents, and attendings evaluating perceptions of intern tiredness, overall satisfaction, and performance. Nursing surveys evaluated intern and medical team performance. Objective outcome measures, including intensive care unit transfers, length of stay, readmissions, mortality, and complications, were assessed through a retrospective, blinded chart review. RESULTS: Patients reported similar satisfaction in care. Extended duty-hour interns reported significantly decreased familiarity with their patients, decreased ability to conduct physical exams on new patients, increased tiredness, and decreased overall satisfaction. Residents overseeing extended-duty interns reported significantly decreased quality in intern presentations and overall quality of teaching, and increased perception of intern tiredness and increased incorrect orders. Attending physicians reported significantly improved quality of new patient presentations by extended duty-hour interns. No significant differences in patient objective outcome measures were noted. CONCLUSIONS: Extended intern duty hours do not affect patient’s satisfaction with their care. Although interns in the extended duty-hour system reported significantly increased fatigue and decreased overall satisfaction and residents’ perceived increases in incorrect intern orders in the extended duty-hour system, there were no detrimental effects on patient safety.
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spelling pubmed-94227542022-09-06 Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes Salgado, Sanjay M. Katz, Joel T. Pelletier, Stephen R. Goodberlet, Melanie Kelly, Julie Duperreault, Megan Ali, Nadaa B. Shields, Helen M. J Patient Saf Original Studies In 2017, interns were permitted to work continuously for up to 28 hours at a time, a reversal from the previously mandated 16-hour limit. Our objective was to evaluate perceptions of care and patient outcomes on an extended (28-hour) compared with a limited (16-hour) duty-hour system on identical interdisciplinary teams. METHODS: Sixty-two interns, 27 residents, 28 attendings, and 449 patients participated. Patients completed surveys assessing their satisfaction. Anonymous weekly surveys were obtained from interns, residents, and attendings evaluating perceptions of intern tiredness, overall satisfaction, and performance. Nursing surveys evaluated intern and medical team performance. Objective outcome measures, including intensive care unit transfers, length of stay, readmissions, mortality, and complications, were assessed through a retrospective, blinded chart review. RESULTS: Patients reported similar satisfaction in care. Extended duty-hour interns reported significantly decreased familiarity with their patients, decreased ability to conduct physical exams on new patients, increased tiredness, and decreased overall satisfaction. Residents overseeing extended-duty interns reported significantly decreased quality in intern presentations and overall quality of teaching, and increased perception of intern tiredness and increased incorrect orders. Attending physicians reported significantly improved quality of new patient presentations by extended duty-hour interns. No significant differences in patient objective outcome measures were noted. CONCLUSIONS: Extended intern duty hours do not affect patient’s satisfaction with their care. Although interns in the extended duty-hour system reported significantly increased fatigue and decreased overall satisfaction and residents’ perceived increases in incorrect intern orders in the extended duty-hour system, there were no detrimental effects on patient safety. Lippincott Williams & Wilkins 2022-09 2022-04-14 /pmc/articles/PMC9422754/ /pubmed/35152234 http://dx.doi.org/10.1097/PTS.0000000000000988 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Studies
Salgado, Sanjay M.
Katz, Joel T.
Pelletier, Stephen R.
Goodberlet, Melanie
Kelly, Julie
Duperreault, Megan
Ali, Nadaa B.
Shields, Helen M.
Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes
title Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes
title_full Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes
title_fullStr Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes
title_full_unstemmed Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes
title_short Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes
title_sort impact of extended duty hours on perceptions of care and objective patient outcomes
topic Original Studies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9422754/
https://www.ncbi.nlm.nih.gov/pubmed/35152234
http://dx.doi.org/10.1097/PTS.0000000000000988
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