title: Resident fatigue: is there a patient safety issue?
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.
authors.affiliation: Methodist Dallas Medical, 1441 N. Beckley Ave., Dallas, TX 75203, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Mitchell
authors.forename: Clark R
authors.initials: CR
authors.lastname: Mooty
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Dunn
authors.forename: Karla C
authors.initials: KC
authors.lastname: Ramberger
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Mangram
mesh_terms: D002983:Clinical Competence; D005221:Fatigue / Q000453:epidemiology; D006801:Humans; D007396:Internship and Residency; D019300:Medical Errors / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012449:Safety; D018571:Sentinel Surveillance