Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. 250-258 (doi:10.1542/peds.2007-2306)

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ARTICLE

Effects of the Accreditation Council for Graduate Medical Education Duty Hour Limits on Sleep, Work Hours, and Safety

Christopher P. Landrigan, MD, MPH^a,b, Amy M. Fahrenkopf, MD, MPH^b, Daniel Lewin, PhD^c, Paul J. Sharek, MD, MPH^d, Laura K. Barger, PhD^a, Melanie Eisner, BS^c, Sarah Edwards, BS^a,b, Vincent W. Chiang, MD^b, Bernhard L. Wiedermann, MD^c, Theodore C. Sectish, MD^b,d

^a Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital
^b Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
^c Department of Pediatrics, Children's National Medical Center, George Washington University, Washington, DC
^d Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford Medical School, Palo Alto, California

OBJECTIVE. To mitigate the risks of fatigue-related medical errors, the Accreditation Council for Graduate Medical Education introduced work hour limits for resident physicians in 2003. Our goal was to determine whether work hours, sleep, and safety changed after implementation of the Accreditation Council for Graduate Medical Education standards.

METHODS. We conducted a prospective cohort study in which residents from 3 large pediatric training programs provided daily reports of work hours and sleep. In addition, they completed reports of near-miss and actual motor vehicle crashes, occupational exposures, self-reported medical errors, and ratings of educational experience. They were screened for depression and burnout. Concurrently, at 2 of the centers, data on medication errors were collected prospectively by using an established active surveillance method.

RESULTS. A total of 220 residents provided 6007 daily reports of their work hours and sleep, and 16 158 medication orders were reviewed. Although scheduling changes were made in each program to accommodate the standards, 24- to 30-hour shifts remained common, and the frequency of residents’ call remained largely unchanged. There was no change in residents’ measured total work hours or sleep hours. There was no change in the overall rate of medication errors, and there was a borderline increase in the rate of resident physician ordering errors, from 1.06 to 1.38 errors per 100 patient-days. Rates of motor vehicle crashes, occupational exposures, depression, and self-reported medical errors and overall ratings of work and educational experiences did not change. The mean length of extended-duration (on-call) shifts decreased 2.7% to 28.5 hours, and rates of resident burnout decreased significantly (from 75.4% to 57.0%).

CONCLUSIONS. Total hours of work and sleep did not change after implementation of the duty hour standards. Although fewer residents were burned out, rates of medication errors, resident depression, and resident injuries and educational ratings did not improve.

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Key Words: patient safet • medical errors • sleep deprivation • work hours • Accreditation Council for Graduate Medical Education • motor vehicle crashes

Abbreviations: ACGME—Accreditation Council for Graduate Medical Education • CI—confidence interval • MVC—motor vehicle crash

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Accepted Nov 26, 2007.

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