The impact of duty hours on resident self reports of errors.
BACKGROUND
Resident duty hour limitations aim, in part, to reduce medical errors. Residents' perceptions of the impact of duty hours on errors are unknown.


OBJECTIVE
To determine residents' self-reported contributing factors, frequency, and impact of hours worked on suboptimal care practices and medical errors.


METHODS
Cross-sectional survey.


METHODS
164 Internal Medicine Residents at the University of California, San Francisco.


RESULTS
Residents were asked to report the frequency and contributing factors of suboptimal care practices and medical errors, and how duty hours impacted these practices and aspects of resident work-life. One hundred twenty-five residents (76%) responded. The most common suboptimal care practices were working while impaired by fatigue and forgetting to transmit information during sign-out. In multivariable models, residents who felt overwhelmed with work (p = 0.02) and who reported spending >50% of their time in nonphysician tasks (p = 0.002) were more likely to report suboptimal care practices. Residents reported work-stress (a composite of fatigue, excessive workload, distractions, stress, and inadequate time) as the most frequent contributing factor to medical errors. In multivariable models, only engaging in suboptimal practices was associated with self-report of higher risk for medical errors (p < 0.001); working more than 80 hours per week was not associated with suboptimal care or errors.


CONCLUSIONS
Our findings suggest that administrative load and work stressors are more closely associated with resident reports of medical errors than the number of hours work. Efforts to reduce resident duty hours may also need to address the nature of residents' work to reduce errors.
Vidyarthi
Arpana R
AR
Department of Medicine, University of California, San Francisco, California 94143-0131, USA. arpana@medicine.ucsf.edu
Auerbach
Andrew D
AD
Wachter
Robert M
RM
Katz
Patricia P
PP
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008505:Medical Staff, Hospital / Q000523:psychology; D010561:Personnel Staffing and Scheduling; D012647:Self-Assessment; D014940:Work Schedule Tolerance / Q000523:psychology; D016526:Workload / Q000523:psychology