The impact of resident working hours on patient outcomes : a systematic review

Abstract

Objectives: Resident working hours might have potential impact on patient outcomes due to the fatigue of bodies, being less attentive resulted from long working hours and that might affect patient care, however, changing the long adopted practice by reducing resident working hours might lead to unintended consequences and this might also affecting patient outcomes. This project aims to investigate how resident working hours correlates to patient outcomes such as length of stay, patient care, continuity of care, patient safety and mortality. Methods: A literature search was conducted in the electronic database PubMed from 2006 to 2016. Information extracted from the included articles includes study year, study design, sample size, specialty and impact on patient outcomes. Results: 15 articles were included in the systematic review. 4 studies examined the perceived patient outcomes of program directors, up to 90% of the program directors perceived there was either no improvement or the patient outcomes were worsened after the implementation of work hour limitations; 6 studies examined the perceived patient outcomes of residents, no significant difference for patient care was found while a certain number of residents believed that work hour limitations would worsen patient safety and contribute to higher rate of medical error; 5 studies examined the actual patient outcomes, part of the studies showed the slightly reduction of length of stay while some studies showed the opposite result, and more studies showed the mortality was decreased. Conclusion: The reduction on residents’ working hours is seemed to be beneficial to patients as lessen tiredness might prevent residents from causing errors. However, unintended consequences may be resulted as residents will have lesser training opportunities and exposures, and the reduced working hours will increase handoffs and affect continuity of care. Therefore, it is necessary to obtain an optimum and appropriate working hour pattern for residents – their working hours shall neither be too long affecting patient outcomes, nor inadequate which may affect the learning exposures, experience training, and the handover of patient. The ideal resident duty hours to maximize patient outcomes are yet to be identified, but the feedbacks from residents are important as they are in the best position to know and comment on how the working hours may affect them in both training perspective and individual quality of life, which are correlated to patient outcomes.