Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Patient Safety
The Institute of Medicine formed a consensus committee to:
1) synthesize current evidence on medical resident schedules and healthcare safety.
2) develop strategies to enable optimization of work schedules to improve safety in the healthcare work environment. The strategies recommended will take into account the learning and experience that residents must achieve during their training. The recommendations will be structured to optimize both the quality of care and the educational objectives.
The committee was asked to deliver its report in 12 months, and thus focused on two priority tasks-each with component tasks as well as related issues to be considered as relevant to the main task but not necessarily studied in depth. Although the issues studied are broad ones, to permit comprehensive coverage of the priority issues in the specified timeframe, the scope was limited to medical residents (versus all physicians or all healthcare workers) and their work schedules (versus all work processes or the entire work environment). The committee was asked to consider the impact of recommended actions on costs; however, a detailed cost analysis was outside the scope of the study.
Task #1: Review and Synthesize Evidence on Optimal Resident Work Schedules, including:
- Evidence on the relationship between resident work schedules, resident performance, and the quality of care delivered by residents-specifically patient safety. Consider also evidence on the safety of the residents, the education and training experience of the residents, the quality of the interactions from both the resident and patient perspective, and other aspects of safety and quality of care such as care hand-offs and transitions.
As relevant, consider evidence on the relationship between sleep, fatigue, work schedules, and performance for other health care professionals as well as generally.
- Evidence on the strategies, practices, interventions, and tools that have been employed in the United States, Australia, Canada, Europe, New Zealand and elsewhere to optimize the work schedules for residents to assure the safety and quality of patient care. Identify barriers to change and strategies for overcoming them. Examine how related issues are handled such as staffing, financial costs, and other resources. Consider also other approaches to the nature of resident work and the role of the resident (such as assigning tasks traditionally assigned to medical residents to other healthcare professionals) and resident training (such as use of simulations).
As relevant, consider approaches to similar issues in other healthcare work environments and other industries as well as more general issues such as teamwork and organizational culture.
Task #2: Develop Strategies for Implementing Optimal Resident Work Schedules
- Make recommendations for how the strategies, practices, interventions, and tools identified in Task #1 can be implemented to optimize resident schedules to improve the safety of the healthcare work environment and the quality of care.
- Recommend actions for stakeholders including residents, hospitals, professional societies, accrediting bodies, administrators and funders of residency training programs, federal and state agencies, and policymakers at all levels. Identify actions that can be taken in the short- and long-term. The recommendations should specify who should take what actions to create a care environment that is safe for patients, residents, and other health workers. Recommendations should also address anticipated barriers to change such as the culture of medical education and health care institutions.
Consider and describe the consequences of these recommended actions for the cost of medical training and of health care. As discussed above, costs are to be considered in general terms--the task is not to develop explicit cost estimates for recommended changes.
This project was sponsored by the Agency for Healthcare Research and Quality, Department of Health and Human Services. The approximate start date for the project was September 4, 2007. A report was issued at the end of the project after approximately 18 months.
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