Abstract
Background
In 2003, the 80-hour resident workweek was implemented in response to concerns that
fatigued residents led to substandard patient care. Existing evidence links fatigue
with impaired human performance; however, this has not consistently translated into
similar impairment in the clinical arena. There is now discussion of additional work
hour restrictions. Sentinel events are major medical mistakes tracked by the Joint
Commission (JC). Root cause analysis of these events can determine if resident fatigue
plays a role in medical errors.
Methods
A retrospective review of sentinel events in our health system from January 2004 to
July 2008 was performed. A root cause analysis for each event was performed. The JC
national databank of sentinel events from 1995 to 2007 was also reviewed. In addition,
a literature search was performed.
Results
At our institution, 110 sentinel events were identified. Root cause analysis showed
no evidence of resident fatigue involvement. The JC's national databank includes 4,817
sentinel events. No documented evidence of resident fatigue was found.
Conclusions
Our data did not provide any evidence to support the contention that resident fatigue
leads to increased medical errors. Clinical data supporting a direct relationship
between resident fatigue and compromised patient safety must be demonstrated before
further work hour restrictions are made. More research must be done. The JC should
consider monitoring sentinel events for resident fatigue.
Keywords
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Article info
Publication history
Received in revised form:
April 10,
2009
Received:
March 5,
2009
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
