Premium
Work hour rules and contributors to patient care mistakes: A focus group study with internal medicine residents
Author(s) -
Fletcher Kathlyn E.,
Parekh Vikas,
Halasyamani Lakshmi,
Kaufman Samuel R.,
Schapira Marilyn,
Ertl Kristyn,
Saint Sanjay
Publication year - 2008
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.288
Subject(s) - graduate medical education , accreditation , workload , medicine , patient safety , focus group , patient care , hospital medicine , family medicine , medline , health care , medical emergency , nursing , medical education , business , marketing , computer science , political science , law , economics , economic growth , operating system
Abstract BACKGROUND: The “Swiss cheese model” of systems accidents is commonly applied to patient safety, implying that many “holes” must align before an adverse event occurs. The Accreditation Council for Graduate Medical Education (ACGME) instituted work hour limitations to fill one such hole by reducing resident fatigue. OBJECTIVE: The objective of this study was to determine how residents perceive the impact of the ACGME rules and other factors on patient safety. DESIGN: The study was designed as a focus group study. PARTICIPANTS: Participating in the study were 28 internal medicine residents, of whom 13 were from a university‐based program that includes both an academic medical center and a Veterans Affair (VA) hospital, 9 were from a community‐based program, and 6 were from a freestanding medical college that includes a large private teaching hospital and a VA hospital. MEASUREMENT: Grounded theory analysis was used to examine transcripts of the focus group discussions. RESULTS: A model of contributors to patient care errors emerged including fatigue, inexperience, sign‐outs, not knowing patients, “entropy” (which we defined as “overall chaos in the system”), and workload. Participants described the impact of both intended and unintended consequences of the work hour rules on patient care. Residents reported improved well‐being and less fatigue, but had concern about the effect of reduced continuity on patient care. CONCLUSION: Our focus group participants perceived that the ACGME work hour limitations had minimized the impact of resident fatigue on patient care errors. Other contributors to errors remained and were often exacerbated by methods to maintain compliance with the rules. Journal of Hospital Medicine 2008;3:228–237.