title: Impact of resident duty hour limits on safety in the intensive care unit: a national survey of pediatric and neonatal intensivists.
abstract: OBJECTIVE
  Resident duty-hour regulations potentially shift the workload from resident to attending physicians. We sought to understand how current or future regulatory changes might impact safety in academic pediatric and neonatal intensive care units.
  
  
  METHODS
  Web-based survey.
  
  
  METHODS
  U.S. academic pediatric and neonatal intensive care units.
  
  
  METHODS
  Attending pediatric and neonatal intensivists.
  
  
  METHODS
  We evaluated perceptions on four intensive care unit safety-related risk measures potentially affected by current duty-hour regulations: 1) attending physician and resident fatigue; 2) attending physician workload; 3) errors (self-reported rates by attending physicians or perceived resident error rates); and 4) safety culture. We also evaluated perceptions of how these risks would change with further duty-hour restrictions.
  
  
  RESULTS
  We administered our survey between February and April 2010 to 688 eligible physicians, of whom 360 (52.3%) responded. Most believed that resident error rates were unchanged or worse (91.9%) and safety culture was unchanged or worse (84.4%) with current duty-hour regulations. Of respondents, 61.9% believed their own work-hours providing direct patient care increased and 55.8% believed they were more fatigued while providing direct patient care. Most (85.3%) perceived no increase in their own error rates currently, but in the scenario of further reduction in resident duty-hours, over half (53.3%) believed that safety culture would worsen and a significant proportion (40.3%) believed that their own error rates would increase.
  
  
  CONCLUSIONS
  Pediatric intensivists do not perceive improved patient safety from current resident duty-hour restrictions. Policies to further restrict resident duty-hours should consider unintended consequences of worsening certain aspects of intensive care unit safety.
authors.affiliation: Houston VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. ktyppo@email.arizona.edu
authors.forename: Katri V
authors.initials: KV
authors.lastname: Typpo
authors.forename: M Hossein
authors.initials: MH
authors.lastname: Tcharmtchi
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.forename: P Adam
authors.initials: PA
authors.lastname: Kelly
authors.forename: Leticia D
authors.initials: LD
authors.lastname: Castillo
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
mesh_terms: D001291:Attitude of Health Personnel; D005221:Fatigue / Q000523:psychology; D005257:Fellowships and Scholarships / Q000458:organization & administration; D005260:Female; D019538:Health Care Surveys; D020445:Hospitalists / Q000458:organization & administration; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000592:standards*; D007396:Internship and Residency / Q000458:organization & administration; D016015:Logistic Models; D008297:Male; D019300:Medical Errors; D015999:Multivariate Analysis; D015279:Organizational Culture; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration / Q000592:standards*; D010820:Physicians / Q000523:psychology*; D018709:Statistics, Nonparametric; D014481:United States; D014940:Work Schedule Tolerance / Q000502:physiology / Q000523:psychology; D016526:Workload