title: Effective implementation of work-hour limits and systemic improvements.
abstract: BACKGROUND
  Sleep deprivation, ubiquitous among nurses and physicians, recently has been shown to greatly increase rates of serious medical errors and occupational injuries among health care workers in the United States.
  The Accreditation Council for Graduate Medical Education's current work-hour limits for physicians-in-training allow work hours well in excess of those proven safe. No regulations limit the work hours of other groups of health care providers in the United States. Consequently, nursing work shifts exceeding 12 hours remain common. Physician-in-training shifts of 30 consecutive hours continue to be endorsed officially, and data demonstrate that even the 30-hour limit is exceeded routinely. By contrast, European health care workers are limited by law to 13 consecutive hours of work and to 48-56 hours of work per week. Except for a few institutions that have eliminated 24-hour shifts, as a whole, the United States lags far behind other industrialized nations in ensuring safe work hours.
  
  
  CONCLUSIONS
  Preventing health care provider sleep deprivation could be an extremely powerful means of addressing the epidemic of medical errors in the United States. Implementation of evidence-based work-hour limits, scientifically designed work schedules, and infrastructural changes, such as the development of standardized handoff systems, are urgently needed.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, USA. clandrigan@rics.bwh.harvard.edu
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Landrigan
authors.forename: Charles A
authors.initials: CA
authors.lastname: Czeisler
authors.forename: Laura K
authors.initials: LK
authors.lastname: Barger
authors.forename: Najib T
authors.initials: NT
authors.lastname: Ayas
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rothschild
authors.forename: Steven W
authors.initials: SW
authors.lastname: Lockley
mesh_terms: D005221:Fatigue; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D009726:Nurses / Q000592:standards; D016134:Organizational Policy; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration* / Q000592:standards; D010820:Physicians / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration; D012892:Sleep Deprivation; D014481:United States