Grant: Partnerships for Health System Improvement (PHSI)

After graduation from medical school, physician education continues in a residency program in the individual's chosen area of specialty (e.g., Surgery, Internal Medicine). Residency programs have grueling schedules with frequent on-call shifts. These shifts are at least 24 hours in length, starting from the morning of one day and extending to the next day. In teaching hospitals, residents often provide first line care and make important decisions independent of direct supervision. Their clinical performance is thus an important determinant of patient safety. Some have argued that shift length should be reduced to a more reasonable amount (e.g. <16 continuous hrs) to reduce fatigue and medical errors, and to improve safety. The main purpose of this study is to assess the impact of eliminating long resident work shifts on patient safety. We will allocate residents working on general medical wards at two hospitals to either the TRADITIONAL SCHEDULE (shifts in excess of 24 hrs every fifth night) or an INTERVENTION SCHEDULE (shiftwork schedule with elimination of shifts>16 hrs in length). We will assess the impact on patient safety and other outcomes (e.g., resident education) by using a combination of quantitative and qualitative techniques (i.e., standardized chart reviews, sleep/activity logs, surveys, focus groups, and interviews). The PRIMARY OUTCOME will be the rate of preventable adverse events (patient harm due to a serious medical error). This research is a joint collaboration between clinical researchers and health services decision makers. Two of the decision makers are responsible for resident scheduling at the two teaching hospitals, and have been intimately involved in formulating the proposed research questions. We hypothesize that patient safety will be improved in the shift work schedule. If this turns out to be the case, adoption of this schedule by residency programs would improve care of Canadians admitted to hospitals across the country.