Long Working Hour Related Medical Errors and Patient Outcomes among Physicians: A Systematic Review
Journal Title: Emergency Medicine – Open Journal - Year 2018, Vol 4, Issue 1
Abstract
Aim Inspired by the famous Libby Zion case in 1984, which revealed the underlying flaw in the medical system at the time──the exploitation of junior medical staff and the inadequate surveillanceby attending physicians, authors of this systemic review aim to investigate the potential consequence of overworking in medical scenarios. Methods Excerpta medica database (EMBASE) and PubMed had been systematically searched, bibliographies of relevant studies additionally reviewed. Four cohorts and three randomized controlled trials were selected and quality-assessed with Newcastle-Ottawa Scale and the Cochrane risk of bias tool, respectively. Literature were extracted and discussed. Results Two randomized controlled trials have concluded that residents or interns with longer consecutive working hours per shift in the division of internal medicineare prone to more medical errors. One cohort study has shown a significant association between longer weekly working hours and worsened quality of patient care (intensive care unit (ICU) transfer rates and in-hospital mortality) in the setting of internal medicine. However, none of the 3 studies which were conducted in surgical departments suggests a further restriction on weekly working hours or shift length. Conclusion The specialty-specific policy is recommended based on our between-study comparison. Specifically, with respect to the incidence of medical errors or adverse events, weekly hours or shift length are weakly recommended to be regulated in the department of internal medicine, but there is no recommendation to surgical departments. However, one must consider all respects of the impact brought by any alternation of working policy before the actual implementation.
Authors and Affiliations
Wei-Yo Chao
Keywords
Related Articles
- EP ID EP548444
- DOI 10.17140/EMOJ-4-151
- Views 145
- Downloads 0
An Overlook at the Patients with Acute Lower Limb Ischemia Undergone Femoral Embolectomy
Objectives: Acute lower extremity ischemia is a rapidly progressive condition that could stem from embolism or thrombus, leading to sudden interruption of blood flow which might cause loss of limb or even mortality. In t...
Time to Rewrite Assessment and Documentation of Acute Pain in the Emergency Setting
As a subjective and a unique individual experience, acute pain is one of the most common chief complaints reported by a majority of patients who are admitted to the emergency department (ED), while its perception and exp...
Non-Invasive Characterization of Oxygen Transport in Sickle Cell Disease: A Pilot Study
Introduction: Vaso-occlusive (VOC) crisis is, in part, a result of microvascular ischemic insults to tissue causing pain in Sickle Cell Disease patients, which is a common presentation to the Emergency Department (ED). T...
A LEAN Approach to Emergency Department Crowding in a Southern California Health System
Background: Emergency Department (ED) crowding has been proven to lead to longer length of stay (LOS) minutes per patient’s arrival. Within AHMC HealthSystem (AHMC) in Fiscal Year (FY) 2016, all facilities experienced a...
Stevens-Johnson Syndrome without Skin Lesions: A Rare and Clinically Challenging Disease in the Urgent Setting
Stevens-Johnson syndrome, toxic epidermal necrolysis, and erythema multiforme are life threatening diseases causing mucocutaneous eruptions and can be difficult to manage medically. When oral tissues are involved, airway...