Original Article
Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units
N Engl J Med 2004; 351:1838-1848October 28, 2004
- Abstract
Background
Although sleep deprivation has been shown to impair neurobehavioral performance, few studies have measured its effects on medical errors.
Methods
We conducted a prospective, randomized study comparing the rates of serious medical errors made by interns while they were working according to a traditional schedule with extended (24 hours or more) work shifts every other shift (an “every third night” call schedule) and while they were working according to an intervention schedule that eliminated extended work shifts and reduced the number of hours worked per week. Incidents were identified by means of a multidisciplinary, four-pronged approach that included direct, continuous observation. Two physicians who were unaware of the interns' schedule assignments independently rated each incident.
Results
During a total of 2203 patient-days involving 634 admissions, interns made 35.9 percent more serious medical errors during the traditional schedule than during the intervention schedule (136.0 vs. 100.1 per 1000 patient-days, P<0.001), including 56.6 percent more nonintercepted serious errors (P<0.001). The total rate of serious errors on the critical care units was 22.0 percent higher during the traditional schedule than during the intervention schedule (193.2 vs. 158.4 per 1000 patient-days, P<0.001). Interns made 20.8 percent more serious medication errors during the traditional schedule than during the intervention schedule (99.7 vs. 82.5 per 1000 patient-days, P=0.03). Interns also made 5.6 times as many serious diagnostic errors during the traditional schedule as during the intervention schedule (18.6 vs. 3.3 per 1000 patient-days, P<0.001).
Conclusions
Interns made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts. Eliminating extended work shifts and reducing the number of hours interns work per week can reduce serious medical errors in the intensive care unit.
Media in This Article
Figure 1
Representative Work Hours during a Single Week for the Whole Team of Interns during the Traditional Schedule (Panel A) and the Intervention Schedule (Panel B).Table 1
Definitions Used in the Study.Article Activity
- Article
In a pioneering study published in the Journal 33 years ago, Friedman and colleagues reported that interns made almost twice as many errors reading electrocardiograms after an extended (24 hours or more) work shift than after a night of sleep.1 More recent studies have similarly found that surgical residents made up to twice the number of technical errors in the performance of simulated laparoscopic surgical skills after working overnight than after a night of sleep.2,3 Although many prior studies have been methodologically limited by the use of nonvalidated self-reports on the timing of sleep and inadequate accounting for circadian phase and chronic sleep loss, as reviewed elsewhere,4-6 the literature as a whole suggests that sleep deprivation causes substantial decrements in physicians' performance of discrete neurocognitive and simulated clinical tasks.4-8 The clinical importance of sleep curtailment has remained unclear, however,4-6 owing to a lack of studies conducted in clinical care environments4,9 and the possibility that scheduling interventions designed to mitigate sleep deprivation may simultaneously introduce discontinuities in care.10,11
Within hospitals, of all trainees, interns (postgraduate year 1) typically work the greatest number of hours per week.12,13 The extended (24 hours or more) work shifts and long workweeks of interns may make them especially prone to fatigue-induced errors. In a survey of house officers, 41 percent reported fatigue as a cause of their most serious mistake. Most of these events occurred while they were interns, and 31 percent reportedly resulted in fatalities.14
To understand the effects of interns' sleep deprivation on serious medical errors, we conducted a comprehensive comparison of errors while interns followed a traditional work schedule and errors while they followed an intervention work schedule that was designed to reduce sleep deprivation. Our goals were to compare the rates of serious errors directly involving interns on the two schedules, since interns were the focus of our scheduling intervention, and to compare the overall rates of serious medical errors in order to track the effects of interns' schedules on the system as a whole.
Methods
The Intern Sleep and Patient Safety Study was conducted as part of the Harvard Work Hours, Health and Safety Study from July 2002 to June 2003 in the medical intensive care unit (MICU) and coronary care unit (CCU) of Brigham and Women's Hospital, a large academic hospital in Boston, after approval by the institutional review board. The MICU and CCU were selected for study because they are the rotations of this internal-medicine training program with the longest work hours and because medical errors have been detected at higher rates in critical care settings than in other settings.15,16 Both units have 10 adult critical care beds. Data were not collected on patients admitted for fewer than four hours, patients undergoing elective allergy desensitization, or the rare patients who boarded on the units but who were not cared for by the MICU or CCU team.
Design of Intervention Trial
In collaboration with the leadership of the residency program and unit directors, we designed an intervention work schedule for interns that eliminated extended (24 hours or more) work shifts and reduced the number of scheduled hours of work to 63 per week (Figure 1Figure 1
Representative Work Hours during a Single Week for the Whole Team of Interns during the Traditional Schedule (Panel A) and the Intervention Schedule (Panel B).). The traditional MICU house-staff team consisted of three interns and three third-year residents, whereas the CCU team consisted of three interns and two second-year residents. Each intern and resident on these teams worked overnight in the hospital every third night. A resident from another hospital service assumed patient care responsibilities in the CCU on nights when neither of the daytime CCU residents was working. Under this rotation, interns' scheduled workweeks averaged 77 to 81 hours, depending on the clinic assignment, with up to 34 continuous hours of scheduled work when clinic occurred after they were on call (Figure 1A).During the intervention schedule, interns' work hours and overnight work schedules were changed. Interns' traditional extended work shifts were divided in two: a “day-call” intern worked the first half of a traditional call (from 7 a.m. to 10 p.m.); a “night-call” intern worked the second half (from 9 p.m. to 1 p.m. the following day). To effect this schedule, four interns shared patient care responsibilities during the rotation. The maximal scheduled hours of work were 60 to 63 per week, with consecutive hours of work limited to approximately 16 hours (Figure 1B). The intervention did not alter the schedules or staffing of second- or third-year residents or other clinical personnel.
Our goal was to improve interns' opportunities to sleep while minimizing errors due to handoffs of patient care and cross-coverage.10 To minimize cross-coverage errors, we developed a sign-out template for interns to use in all critical care rotations (both intervention and traditional schedules)17 and incorporated an hour of overlap in the evenings for interns on the intervention schedule to sign out formally (see Figure A of the Supplementary Appendix, available with the full text of this article at www.nejm.org) under the supervision of the senior resident.
After providing written informed consent, interns were randomly assigned to work either the intervention schedule in the CCU and the traditional schedule in the MICU or the converse; these rotations were distributed throughout the year. Data collected during a pilot intervention schedule involving four interns that was discontinued after the first ICU rotation were not included. As detailed in the article by Lockley et al. in this issue of the Journal, 18 although actual work hours often exceeded those scheduled during both the traditional and intervention schedules, the intervention successfully eliminated shifts of 24 hours or more, reduced the number of hours worked by interns by nearly 20 per week, increased the average daily duration of sleep by nearly an hour, and reduced attentional failures.
Data Collection and Classification
To measure patients' safety during the two schedules, we developed an intensive system of data collection and evaluation that expanded on methods previously used in the study of medication errors16,19 and also included continuous observation of interns by physicians. In this study, we focused on procedural and diagnostic errors in addition to medication errors. The definitions used to classify incidents are provided in Table 1Table 1
Definitions Used in the Study..A team of two nurse chart reviewers and six physician observers collected data, supplemented by voluntary reports from clinical staff and a computerized event-detection monitor. Direct observation was the principal means of detecting serious errors in which interns were directly involved; physician observers followed study interns continuously, day and night in the hospital. In the afternoons after work rounds, when more than one intern was working simultaneously, only one intern was observed at a time owing to staffing limitations. Residents and other personnel on the units were not directly observed. Data collection for personnel other than interns was less comprehensive and relied on chart review, voluntary reports, and computerized event-detection monitoring. Other methods of data collection, though less comprehensive, were designed to identify all serious medical errors — both those in which interns were involved and those in which they were not involved. Before beginning data collection, all staff received intensive training in the consistent, objective collection of data using standardized forms. Because it was not possible to blind data collectors to the study schedule, determinations of the preventability and classification of events were not made by the primary data collectors. Instead, each suspected error or adverse event identified was independently rated by two physician investigators who were unaware of the identity of those involved or whether the incident occurred during the traditional or intervention schedule.
In the vast majority of cases, the serious errors identified by observers were promptly addressed by medical staff with no need for action on the part of the observers. Nonintercepted serious errors were generally detected by observers when they were discussed by clinical staff. In the handful of cases in which observers identified possible errors in the making with substantial potential to cause harm, they immediately alerted clinical staff to prevent harm to the patient.
Blinded reviewers categorized each incident as an adverse event, nonintercepted serious error, intercepted serious error, or error with little potential for harm (a category that was excluded from the analysis) and rated the preventability of adverse events using a Likert scale (was prevented, was definitely preventable, was probably preventable, was probably not preventable, or was definitely not preventable); the preventability scale was dichotomized to include only “preventable events” and “nonpreventable events” before analysis. Events deemed more likely to be due to patients' underlying illness than to medical therapy were excluded. Disagreements were resolved by discussion; the interrater reliability was calculated before such discussion by means of the kappa statistic, as described below.
Statistical Analysis
Patients' characteristics and the mean daily census of the units during the intervention and traditional rotations were compared by means of Fisher's exact test; Wilcoxon's nonparametric test for dichotomous, nonnormally distributed continuous variables; and a t-test for normally distributed continuous variables. All statistical tests were two-tailed. The rates of diagnostic tests and procedures per patient-day were compared between the two schedules, and the distribution was assumed to be binomial. We compared the rates of medication orders per patient-day between the two schedules, assuming a Poisson distribution, since the presence of rates of more than one order per patient-day precluded the use of the binomial distribution.
We compared the rates of intern-associated serious medical errors per patient-day (for all interns combined) and of total serious medical errors per patient-day between the intervention and traditional schedules, assuming a binomial distribution. The rates of all serious medical errors include all intern-associated serious errors (those detected by direct observation and other methods) plus non–intern-associated errors (identified by chart review, staff reports, and the computerized monitor). We also compared the rates of type-specific errors (medication, procedural, and diagnostic) per patient-day, assuming a binomial distribution. For all tests, two-tailed P values of less than 0.05 were considered to indicate statistical significance.
The study was powered to determine differences in rates of serious medical errors. Analyses of the rates of adverse events were performed, but the results were considered exploratory since we had only 11 percent power to detect a 25 percent difference in intern-associated preventable adverse events. By contrast, the study was designed to have 80 percent power to detect a 16 percent difference in the rate of serious errors between groups.
We evaluated the reliability of the primary data-collection process by conducting dual direct observation for a total of 10 patient-days; there was 82 percent agreement between independent observers with respect to the occurrence of a serious medical error. At the review stage conducted by the blinded investigators, we performed comprehensive reliability testing of all incidents rated using the kappa statistic. For reviewers' judgments about whether an incident was an adverse event, an intercepted serious error, a nonintercepted serious error, or an excluded event, the κ was 0.90; the κ was 0.80 for the preventability of adverse events.
Results
Patient Population
The study involved 2203 patient-days (1294 during the traditional schedule and 909 during the intervention schedule), representing 634 admissions to the units (385 during the traditional schedule and 249 during the intervention schedule) and 5888 hours of direct observation of interns. The patients' characteristics and the units' characteristics were very similar during the traditional and intervention schedules (Table 2Table 2
Characteristics of the Patients and the System.). The number of days included in the traditional schedule exceeded that of the intervention schedule primarily because four interns were required for the intervention schedule as compared with only three for the traditional schedule. Since all interns rotated through both schedules, more traditional than intervention rotations were required to allow each intern to spend three weeks on each schedule. The patients' length of stay and mortality rate did not differ significantly between the two schedules.Serious Medical Errors by Interns
Interns made 35.9 percent more serious medical errors during the traditional schedule than during the intervention schedule (136.0 vs. 100.1 per 1000 patient-days, P<0.001) (Table 3Table 3
Incidence of Serious Medical Errors.). Interns made 27.8 percent more serious errors that were intercepted during the traditional schedule than during the intervention schedule (70.3 vs. 55.0 per 1000 patient-days, P=0.02) and 56.6 percent more nonintercepted serious errors that reached the patients (44.8 vs. 28.6 per 1000 patient-days, P<0.001). The rates of preventable adverse events did not differ significantly between the two schedules.All Serious Medical Errors and Adverse Events
The rate of all serious medical errors was 22.0 percent higher during the traditional schedule than during the intervention schedule (193.2 vs. 158.4 per 1000 patient-days, P<0.001) (Table 3). Intercepted serious errors occurred 37.2 percent more frequently during the traditional schedule than during the intervention schedule (95.1 vs. 69.3 per 1000 patient-days, P<0.001). The overall rates of nonintercepted serious errors did not differ significantly between the two schedules, nor did the rates of preventable adverse events. There was no significant difference in the rates of total adverse events (preventable plus nonpreventable) between the traditional and intervention schedules (85.0 vs. 93.5 per 1000 patient-days, P=0.31). Secondary analysis of the rates of serious medical errors in which interns were not involved revealed no significant differences between the traditional schedule and the intervention schedule (40.2 vs. 38.5 per 1000 patient-days, P=0.69).
Types of Serious Medical Errors
Interns made 20.8 percent more serious medication errors during the traditional schedule than during the intervention schedule (99.7 vs. 82.5 per 1000 patient-days, P=0.03). Interns made 5.6 times as many serious diagnostic errors during the traditional schedule as during the intervention schedule (18.6 vs. 3.3 per 1000 patient-days, P<0.001). The rates of serious procedural errors among interns did not differ significantly between the two schedules (Table 3).
Analysis of the types of all errors (errors made by interns plus errors in which interns were not involved) showed similar patterns (Table 3). Serious medication errors occurred 17.1 percent more frequently during the traditional schedule than during the intervention schedule (135.2 vs. 115.5 per 1000 patient-days, P=0.03). The rates of serious procedural errors did not differ significantly between the two schedules. Serious diagnostic errors were nearly twice as common during the traditional schedule as during the intervention schedule (21.6 vs. 11.0 per 1000 patient-days, P<0.001).
Examples of each type of serious medical error and adverse event observed in the study are provided in Table 4Table 4
Examples of Serious Medical Errors and Nonpreventable Adverse Events.. Subcategories of medication and nonmedication errors are available in Table A of the Supplementary Appendix.Discussion
Interns made 36 percent more serious medical errors during a traditional work schedule than during an intervention schedule that eliminated extended work shifts. These included significantly more serious medication errors and 5.6 times as many serious diagnostic errors. As a consequence, the overall rates of serious medical errors were significantly higher during the traditional schedule than during the intervention schedule. Fortunately, most serious medical errors were either intercepted or did not result in clinically detectable harm to the patient. Although the study was not designed to have sufficient statistical power to detect a difference in preventable adverse events, the incidence of intern-associated preventable adverse events was 27 percent higher during the traditional schedule than during the intervention schedule, a difference that was not statistically significant (20.9 vs. 16.5 per 1000 patient-days, P=0.21). The overall rates of preventable adverse events (intern-associated and non–intern-associated) were not significantly different during the traditional and intervention schedules (38.6 and 38.5 per 1000 patient-days, respectively; P=0.91), although our intervention and observations were focused on the interns. This study was not designed or powered to assess comprehensively the effect of the intervention on adverse event rates in the units as a whole. Therefore, it remains to be determined whether the decrease in the rate of serious medical errors by interns will translate into a reduction in the rate of adverse events.
The prospective, randomized nature of this study allowed for a rigorous evaluation of the effects on patients' safety of an intervention designed to improve interns' sleep and thus decrease medical errors. Prior studies using before-and-after cohort designs to assess the effects of scheduling interventions have provided limited and conflicting data. A before-and-after analysis of a scheduling intervention in one hospital that reduced residents' work hours and decreased cross-coverage of unfamiliar patients by senior residents found that the efficiency of care increased and the rates of errors among residents decreased.20 In contrast, an unblinded, retrospective study of a New York State regulation that decreased the number of hours worked by house staff but increased cross-coverage found that the efficiency of care declined and rates of medical complications increased.11 Each was limited by a before-and-after design, which precluded the exclusion of secular trends, increasing experience of house staff, cohort effects, or other external confounders as possible explanations for the changes. Because of concurrent changes in work hours, cross-coverage, and other aspects of care in these studies, it was not possible to identify the elements that may have been responsible for the findings.
The overall incidence of serious errors and adverse events we detected is similar to that reported in other studies of patients' safety in the ICU. For example, Giraud et al.21 and Rubins and Moskowitz22 documented the occurrence of 13 to 40 preventable adverse events per 1000 patient-days. The Harvard Medical Practice Study23 reported lower rates but used a less comprehensive method of data collection and a more restrictive definition of harm, since it sought to detect injuries due to negligence. Donchin et al. reported a higher rate of 1.7 errors per patient-day but included errors with little potential for harm.15 The rates detected by Donchin et al. may also be higher because they focused on errors in the unit as a whole, whereas we directly observed only interns. Moreover, during daytime hours, when two or more interns were working simultaneously in different parts of the units, our staffing limitations allowed us to observe only one intern at a time. Consequently, the true rate of serious errors in the units as a whole may have been higher.
The article by Lockley et al.18 demonstrates that eliminating extended work shifts and reducing the number of hours worked by interns led to significant improvements in interns' sleep and reductions in attentional failures. Although causality cannot be established, it was our a priori hypothesis that increases in sleep resulting from the elimination of extended work shifts and reduction of work hours would lead to a decrease in serious medical errors.24 There were no significant differences between the two schedules in the patients' severity of illness or other individual or systemic variables that could independently account for the observed differences in the rates of medical errors. Our randomized study design greatly diminished the likelihood of hidden confounding owing to secular trends, seasonal effects, learning over the course of the year, or other external factors unrelated to our study.
Before we initiated the intervention schedule, concern was expressed that decreasing the number of hours interns worked might diminish their role in the units, thereby shifting the burden of order writing and procedures and, hence, the risk of errors to more senior staff. Our results did not bear out this concern: the number of medications ordered and tests interpreted by interns per patient-day did not differ significantly between the two schedules, and interns performed significantly more procedures per patient-day during the intervention schedule. Moreover, the error rates among senior residents and other staff members were not increased during the intervention schedule. Thus, the substantially lower rates of errors by interns during the intervention schedule cannot be due to shifting of errors to more senior staff.
The Institute of Medicine's report “To Err Is Human”25 was notably silent regarding the issue of sleep deprivation, largely because data directly linking sleep deprivation and medical error have been lacking. Our study helps to fill this knowledge gap and provides data suggesting that the sleep deprivation associated with the traditional extended shifts of 24 hours or more worked by interns may contribute to the high risk of medical errors in critical care units.
It is important to emphasize that not all interventions that reduce interns' work hours will increase interns' sleep26 or improve patients' safety. Schedule design is a critical factor in determining the extent to which around-the-clock work schedules disrupt wake–sleep cycles, even when the number of weekly work hours remains the same.27 Furthermore, any systemic intervention that reduces work hours necessarily increases either providers' workload (i.e., the number of patients covered by a provider at any time) or the number of handoffs in care between medical personnel on shorter work shifts. Either can lead to increased rates of errors and adverse events.10 “Night-float” systems, which use residents on night shifts to allow physicians working extended work shifts protected time for sleep, have their own set of risks. Night-float residents often know patients less well than do other team members (particularly if multiple residents share responsibilities as night floats over the course of a week, or if night floats are responsible for an increased number of patients), and may themselves be sleep-deprived and error-prone.28 For these reasons, we ultimately decided not to implement a night-float system as a means of reducing interns' work hours, as originally planned.24 Our data support the hypothesis that elimination of extended work shifts in a system that minimizes cross-coverage can improve patients' safety. These gains might not be realized in systems that use extensive cross-coverage.
Although our intervention decreased the rate of serious errors overall, our efforts to optimize the sign-out process were only partially successful. The computerized template was never fully adopted, and the effectiveness of the planned evening sign-out was frequently suboptimal. Although some groups of interns worked successfully as teams and effectively signed out every evening, even in the absence of formal training in team management, others did not. In the latter case, the night-call intern was often unaware of historical details regarding patients admitted by the day-call intern and sometimes performed poorly when describing these patients on morning rounds. This led to a widespread impression that communication on the intervention schedule was problematic, making the improvements in patients' safety we observed all the more remarkable. We suggest that future scheduling interventions address this issue by adding formal evening rounds for the entire team. Such improvements, coupled with the elimination of extended work shifts, could further improve patients' safety.
Our study has several limitations. The intervention schedule improved work hours but still involved shifts that were long enough to induce a number of attentional failures that was greater than would be expected among fully rested people.18 We studied two ICUs in a single hospital, and our results may not be generalizable to other settings. In addition, although our study was very large as compared with prior observational safety studies,15 the study was not powered to detect differences in the rates of preventable adverse events. Larger-scale, multicenter trials are needed to investigate this aspect.
Another important limitation was our inability to blind the medical observers to the schedule of the interns, an issue commonly encountered in investigations of systemic interventions to maximize patients' safety. We addressed this in two ways: first, we instructed observers — none of whom were study investigators — in the importance of consistent, objective detection of serious errors, regardless of study schedule. Second, all initial observations were also reviewed by two independent investigators who were blinded to the study's conditions and who classified incidents with extremely high reliability. Nonetheless, we cannot exclude the possibility that some bias may have resulted from the inability to blind the primary detection process, though our reliability data suggest that this bias was probably minimal.
Notably, our data on the high incidence of intercepted serious errors in ICU settings indicate that the ability of other personnel to act as interns' safety net — nurses, pharmacists, and senior medical staff — is very important in preventing injury to patients as a result of interns' errors. Therefore, future studies should seek to improve and measure objectively the sleep and performance of all clinical unit personnel, since team performance may critically affect patients' safety.29 Having interns on a different schedule than supervising residents may have introduced discontinuities in education and interfered with the traditional resident–intern mentorship bond. We would recommend that future studies investigate the effects of eliminating the extended work shifts of interns and senior residents, both to avoid this problem and because it is unlikely that interns are uniquely susceptible to the adverse effects of sleep deprivation.
Prior interventions that have proved successful in reducing serious medical errors in ICU settings have included the use of computerized provider order entry (CPOE)30 and on-site monitoring of orders by clinical pharmacists.31 The higher intern-associated rate of serious medical errors during the traditional schedule, even in the presence of CPOE, clinical pharmacists, unrestricted use of caffeine by interns,32 and a perceived increase in the risk of handoff errors, indicates the extent of impairment associated with extended work shifts. This observation corroborates the prior experimental finding that a single night of continuous sleep deprivation causes decrements in performance similar to those induced by a blood alcohol level of 0.10 percent.33
By reducing consecutive and weekly work hours, our scheduling intervention attempted to address both acute sleep deprivation and chronic partial sleep deprivation. By reducing interns' sleep deprivation and, hence, depth of subsequent sleep, we also indirectly addressed the adverse effects of sleep inertia (i.e., an increased tendency to err on awakening) on performance, since such impairment is a function of sleep depth.34 The schedule was also designed to attenuate the circadian performance nadir by taking advantage of the blunting of this nadir that occurs when the homeostatic sleep drive is lower.35,36 By providing interns with the opportunity to sleep in the afternoon before working overnight, the schedule thereby muted the effect of circadian misalignment on performance. Medical or surgical simulators could help isolate the effects of these interacting factors, since the relative importance of these variables remains unclear. Strategic use of a novel regimen of caffeine32 or ambient light of specific intensity and wavelengths37,38 may further mitigate the deterioration in performance resulting from circadian misalignment.
In conclusion, the rates of serious medical errors in two ICUs were lowered by eliminating extended work shifts and reducing the number of hours interns worked each week. Our results may have important implications for health policy, since more than 100,000 physicians are currently in training in the United States.39 Most of these residents are regularly scheduled to work 30-hour shifts, since extended work shifts and long workweeks continue to be permitted, even under the scheduling reforms instituted last year by the Accreditation Council for Graduate Medical Education. Further modifications of these standards, particularly with respect to the duration of work shifts, may be needed to improve patients' safety in teaching hospitals nationwide.
Supported by a grant (RO1 HS12032) from the Agency for Healthcare Research and Quality (AHRQ), affording data-confidentiality protection by federal statute (Public Health Service Act 42 U.S.C.); by a grant (RO1 OH07567) from the National Institute for Occupational Safety and Health, which provided a Certificate of Confidentiality for data protection; by the Department of Medicine, Brigham and Women's Hospital; by the Division of Sleep Medicine, Harvard Medical School; by the Brigham and Women's Hospital; and by a General Clinical Research Center grant (M01 RR02635) from the National Center for Research Resources. Dr. Landrigan is the recipient of an AHRQ career development award (K08 HS13333); Dr. Cronin is the recipient of an AHRQ National Research Service Award (F32 HS14130) and a National Heart, Lung, and Blood Institute fellowship in the program of training in Sleep, Circadian, and Respiratory Neurobiology at Brigham and Women's Hospital (T32 HL079010); Dr. Lockley is the recipient of a traveling fellowship from the Wellcome Trust, United Kingdom (060018/B/99/Z); and Dr. Czeisler is supported in part by the National Space Biomedical Research Institute through NASA (NCC 9-58).
We are indebted to our data-collection team, without whom this project could not have occurred; to Patricia Aboagye-Kumi, M.D., Megan Callahan, M.D., Vilma L. Castenada, M.D., Rajneesh S. Hazarika, M.B., B.S., Kristina Martell-Waldrop, R.N., Tamara Sikharulidze, M.D., Noma Rehman, M.D., and Victor Tsveybel, R.N., for their hard work and dedication; to the house staff, attending physicians, nurses, and clinical pharmacists of the CCU and MICU for their ongoing support; to Victor J. Dzau, M.D., Anthony D. Whittemore, M.D., Jeffrey Otten, Matthew Van Vranken, Gary L. Gottlieb, M.D., M.B.A., and Joseph Martin, M.D., Ph.D., for their support and leadership in fostering this study; and to Laura K. Barger, Ph.D., M.P.H., Erin E. Evans, B.S., R.P.S.G.T., Heather L. Gornik, M.D., and DeWitt C. Baldwin, Jr., M.D., for assistance in designing and coordinating the many facets of this effort.
Source Information
From the Divisions of Sleep Medicine (C.P.L., J.W.C., S.W.L., C.A.C.), General Internal Medicine (J.M.R., R.K., E.B., D.W.B.), Infectious Disease (J.T.K.), Pulmonary and Critical Care Medicine (J.W.C., C.M.L.), and Cardiology (P.H.S.) and the Internal Medicine Residency Program (J.T.K.), Department of Medicine, Brigham and Women's Hospital; the Division of Sleep Medicine, Harvard Medical School (C.P.L., J.W.C., S.W.L., C.A.C.); and the Division of General Pediatrics, Department of Medicine, Children's Hospital Boston and Harvard Medical School (C.P.L.) — all in Boston.
Address reprint requests to Dr. Landrigan at the Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Ave., Boston, MA 02115, or at clandrigan@rics.bwh.harvard.edu.
- References
References
1
Friedman RC ,Bigger JT ,Kornfeld DS . The intern and sleep loss. N Engl J Med 1971;285:201-203
Full Text | Web of Science | Medline2
Grantcharov TP ,Bardram L ,Funch-Jensen P ,Rosenberg J . Laparoscopic performance after one night on call in a surgical department: prospective study. BMJ 2001;323:1222-1223
CrossRef | Web of Science | Medline3
Eastridge BJ ,Hamilton EC ,O'Keefe GE , et al. Effect of sleep deprivation on the performance of simulated laparoscopic surgical skill. Am J Surg 2003;186:169-174
CrossRef | Web of Science | Medline4
Gaba DM ,Howard SK . Fatigue among clinicians and the safety of patients. N Engl J Med 2002;347:1249-1255
Full Text | Web of Science | Medline5
Veasey S ,Rosen R ,Barzansky B ,Rosen I ,Owens J . Sleep loss and fatigue in residency training: a reappraisal. JAMA 2002;288:1116-1124
CrossRef | Web of Science | Medline6
Weinger MB ,Ancoli-Israel S . Sleep deprivation and clinical performance. JAMA 2002;287:955-957
CrossRef | Web of Science | Medline7
Samkoff JS ,Jacques CHM . A review of studies concerning effects of sleep deprivation and fatigue on residents' performance. Acad Med 1991;66:687-693
CrossRef | Web of Science | Medline8
Pilcher JJ ,Huffcutt AI . Effects of sleep deprivation on performance: a meta-analysis. Sleep 1996;19:318-326
Web of Science | Medline9
Buysse DJ ,Barzansky B ,Dinges D , et al. Sleep, fatigue, and medical training: setting an agenda for optimal learning and patient care. Sleep 2003;26:218-225
Medline10
Petersen LA ,Brennan TA ,O'Neil AC ,Cook EF ,Lee TH . Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med 1994;121:866-872
Web of Science | Medline11
Laine C ,Goldman L ,Soukup JR ,Hayes JG . The impact of a regulation restricting medical house staff working hours on the quality of patient care. JAMA 1993;269:374-378
CrossRef | Web of Science | Medline12
Schwartz RJ ,Dubrow TJ ,Rosso RF ,Williams RA ,Butler JA ,Wilson SE . Guidelines for surgical residents' working hours: intent vs reality. Arch Surg 1992;127:778-782
Web of Science | Medline13
Baldwin DC Jr ,Daugherty SR ,Tsai R ,Scotti MJ Jr . A national survey of residents' self-reported work hours: thinking beyond specialty. Acad Med 2003;78:1154-1163
CrossRef | Web of Science | Medline14
Wu AW ,Folkman S ,McPhee SJ ,Lo B . Do house officers learn from their mistakes? JAMA 1991;265:2089-2094
CrossRef | Web of Science | Medline15
Donchin Y ,Gopher D ,Olin M , et al. A look into the nature and causes of human errors in the intensive care unit. Crit Care Med 1995;23:294-300
CrossRef | Web of Science | Medline16
Kaushal R ,Bates DW ,Landrigan C , et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001;285:2114-2120
CrossRef | Web of Science | Medline17
Petersen LA ,Orav EJ ,Teich JM ,O'Neil AC ,Brennan TA . Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Comm J Qual Improv 1998;24:77-87
Medline18
Lockley SW ,Cronin JW ,Evans EE , et al. Effect of reducing interns' weekly work hours on sleep and attentional failures. N Engl J Med 2004;351:1829-1837
Full Text | Web of Science | Medline19
Bates DW ,Boyle DL ,Vander Vliet MB ,Schneider J ,Leape LL . Relationship between medication errors and adverse drug events. J Gen Intern Med 1995;10:199-205
CrossRef | Web of Science | Medline20
Gottlieb DJ ,Parenti CM ,Peterson CA ,Lofgren RP . Effect of a change in house staff work schedule on resource utilization and patient care. Arch Intern Med 1991;151:2065-2070
CrossRef | Web of Science | Medline21
Giraud T ,Dhainaut JF ,Vaxelaire JF , et al. Iatrogenic complications in adult intensive care units: a prospective two-center study. Crit Care Med 1993;21:40-51
CrossRef | Web of Science | Medline22
Rubins HB ,Moskowitz MA . Complications of care in a medical intensive care unit. J Gen Intern Med 1990;5:104-109
CrossRef | Web of Science | Medline23
Brennan T ,Leape LL ,Laird NM , et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. N Engl J Med 1991;324:370-376
Full Text | Web of Science | Medline24
Lamberg L . Long hours, little sleep: bad medicine for physicians-in-training? JAMA 2002;287:303-306
CrossRef | Web of Science | Medline25
Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Washington, D.C.: National Academy Press, 1999.
26
Richardson GS ,Wyatt JK ,Sullivan JP , et al. Objective assessment of sleep and alertness in medical house staff and the impact of protected time for sleep. Sleep 1996;19:718-726
Web of Science | Medline27
Czeisler CA ,Moore-Ede MC ,Coleman RH . Rotating shift work schedules that disrupt sleep are improved by applying circadian principles. Science 1982;217:460-463
CrossRef | Web of Science | Medline28
Cavallo A ,Ris MD ,Succop P . The night float paradigm to decrease sleep deprivation: good solution or a new problem? Ergonomics 2003;46:653-663
CrossRef | Web of Science | Medline29
Leape LL ,Berwick DM ,Bates DW . What practices will most improve safety? Evidence-based medicine meets patient safety. JAMA 2002;288:501-507
CrossRef | Web of Science | Medline30
Bates DW ,Leape LL ,Cullen DJ , et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998;280:1311-1316
CrossRef | Web of Science | Medline31
Leape LL ,Cullen DJ ,Clapp MD , et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 1999;282:267-270[Erratum, JAMA 2000;283:1293.]
CrossRef | Web of Science | Medline32
Wyatt JK ,Cajochen C ,Ritz-De Cecco A ,Czeisler CA ,Dijk DJ . Low-dose repeated caffeine administration for circadian-phase-dependent performance degradation during extended wakefulness. Sleep 2004;27:374-381
Web of Science | Medline33
Dawson D ,Reid K . Fatigue, alcohol and performance impairment. Nature 1997;388:235-235
CrossRef | Web of Science | Medline34
Dinges DF. Are you awake? Cognitive performance and reverie during the hypnopompic state. In: Bootzin R, Kihlstrom J, Schacter DL, eds. Sleep and cognition. Washington, D.C.: American Psychological Association, 1990:159-75.
35
Jewett ME ,Kronauer RE . Interactive mathematical models of subjective alertness and cognitive throughput in humans. J Biol Rhythms 1999;14:588-597
CrossRef | Web of Science | Medline36
Wyatt JK ,Ritz-De Cecco A ,Czeisler CA ,Dijk DJ . Circadian temperature and melatonin rhythms, sleep, and neurobehavioral function in humans living on a 20-h day. Am J Physiol 1999;277:R1152-R1163
Web of Science | Medline37
Czeisler CA ,Johnson MP ,Duffy JF ,Brown EN ,Ronda JM ,Kronauer RE . Exposure to bright light and darkness to treat physiologic maladaptation to night work. N Engl J Med 1990;322:1253-1259
Full Text | Web of Science | Medline38
Lockley SW ,Brainard GC ,Czeisler CA . High sensitivity of the human circadian melatonin rhythm to resetting by short wavelength light. J Clin Endocrinol Metab 2003;88:4502-4505
CrossRef | Web of Science | Medline39
Accreditation Council for Graduate Medical Education. Number of programs and filled positions by specialty for the current academic year (Ending June 30th, 2005). (Accessed October 4, 2004, at http://www.acgme.org/adspublic/reports/specialty_prognum.asp.)
- Citing Articles (311)
Citing Articles
1
Martina Rojnic Kuzman, Kajsa B. Norstrom, Stephanie Colin, Clare Oakley, Joseph Stoklosa. 2012. Training in Psychiatry Today: European and US Perspectives. , 1-17.
CrossRef2
Russell J. Nauta. (2012) Residency Training Oversight(s) in Surgery: The History and Legacy of the Accreditation Council for Graduate Medical Education Reforms. Surgical Clinics of North America 92:1, 117-123
CrossRef3
A. Markewitz, N. Haake, G. Trummer, G. Marggraf, A. Beckmann. (2012) Empfehlungen der Deutschen Gesellschaft für Thorax-, Herz- und Gefäßchirurgie zur personellen, infrastrukturellen und apparativen Ausstattung einer herzchirurgischen Intermediate-Care-Station. Zeitschrift für Herz-,Thorax- und Gefäßchirurgie
CrossRef4
Stephanie K. Mueller, Stephanie A. Call, Furman S. McDonald, Andrew J. Halvorsen, Jeffrey L. Schnipper, LeRoi S. Hicks. (2012) Impact of Resident Workload and Handoff Training on Patient Outcomes. The American Journal of Medicine 125:1, 104-110
CrossRef5
Joseph S. Alpert, William H. Frishman. (2012) A Bridge too Far: A Critique of the New ACGME Duty Hour Requirements. The American Journal of Medicine 125:1, 1-2
CrossRef6
Suzanne. Ftouni, Tracey L. Sletten, Laura K. Barger, Steven W. Lockley, Shantha M.W. Rajaratnam. 2012. Shift Work Disorder. , 378-389.
CrossRef7
Mari S. Machi, Matthew Staum, Clifton W. Callaway, Charity Moore, Kwonho Jeong, Joe Suyama, P. Daniel Patterson, David Hostler. (2012) The Relationship Between Shift Work, Sleep, and Cognition in Career Emergency Physicians. Academic Emergency Medicineno-no
CrossRef8
M. H. Jamal, S. A. R. Doi, M. Rousseau, M. Edwards, C. Rao, J. J. Barendregt, L. Snell, S. Meterissian. (2012) Systematic review and meta-analysis of the effect of North American working hours restrictions on mortality and morbidity in surgical patients. British Journal of Surgeryn/a-n/a
CrossRef9
Eric W. Schaefer, Mark V. Williams, Phyllis C. Zee. (2012) Sleep and circadian misalignment for the hospitalist: A review. Journal of Hospital Medicinen/a-n/a
CrossRef10
M.H.J. Zwieten, I.L.D. Houtman, D.J. Klein Hesselink. (2011) Impact van afwijkende werktijden: wat weten we vanuit de wetenschappelijke literatuur?. Tijdschrift voor bedrijfs- en verzekeringsgeneeskunde
CrossRef11
Pamela Tan, Nancy J. Hogle, Warren D. Widmann. (2011) Limiting PGY 1 Residents to 16 Hours of Duty: Review and Report of a Workshop. Journal of Surgical Education
CrossRef12
Michael J. Droller. (2011) It's a Matter of Time. The Journal of Urology 186:6, 2149-2150
CrossRef13
Kyle M. Fargen, Anindita Chakraborty, William A. Friedman. (2011) Results of a National Neurosurgery Resident Survey on Duty Hour Regulations. Neurosurgery 69:6, 1162-1170
CrossRef14
Patrick S. Romano, Kevin Volpp. (2011) The ACGME’s 2011 Changes to Resident Duty Hours: Are They an Unfunded Mandate on Teaching Hospitals?. Journal of General Internal Medicine
CrossRef15
B. Chousterman, R. Pirracchio. (2011) De l’iatrogénèse aux erreurs médicales : mise au point et approche analytique. Annales Françaises d'Anesthésie et de Réanimation
CrossRef16
M.-A. Doppia, M. Estryn-Béhar, C. Fry, K. Guetarni, T. Lieutaud. (2011) Enquête comparative sur le syndrome d’épuisement professionnel chez les anesthésistes réanimateurs et les autres praticiens des hôpitaux publics en France (enquête SESMAT). Annales Françaises d'Anesthésie et de Réanimation 30:11, 782-794
CrossRef17
Madeleine Estryn-Behar, Jean-Michel Lassaunière, Clémentine Fry, Alix de Bonnières. (2011) L’interdisciplinarité diminue-t-elle la souffrance au travail ? Comparaison entre soignants de toutes spécialités (médecins et infirmiers) avec ceux exerçant en soins palliatifs, en onco-hématologie et en gériatrie. Médecine Palliative : Soins de Support - Accompagnement - Éthique
CrossRef18
Marten J. Poley, Cynthia van der Starre, Ada van den Bos, Monique van Dijk, Dick Tibboel. (2011) Patient safety culture in a Dutch pediatric surgical intensive care unit: An evaluation using the Safety Attitudes Questionnaire. Pediatric Critical Care Medicine 12:6, e310-e316
CrossRef19
Stephen M. Pastores, Michael F. OʼConnor, Ruth M. Kleinpell, Lena Napolitano, Nicholas Ward, Heatherlee Bailey, Fred P. Mollenkopf, Craig M. Coopersmith. (2011) The Accreditation Council for Graduate Medical Education resident duty hour new standards: History, changes, and impact on staffing of intensive care units*. Critical Care Medicine 39:11, 2540-2549
CrossRef20
Jonathan Smallwood, Michael D Mrazek, Jonathan W Schooler. (2011) Medicine for the wandering mind: mind wandering in medical practice. Medical Education 45:11, 1072-1080
CrossRef21
Michal Tamuz, Traber Davis Giardina, Eric J. Thomas, Shailaja Menon, Hardeep Singh. (2011) Rethinking resident supervision to improve safety: From hierarchical to interprofessional models. Journal of Hospital Medicine 6:8, 448-456
CrossRef22
, Andreas Valentin, Patrick Ferdinande. (2011) Recommendations on basic requirements for intensive care units: structural and organizational aspects. Intensive Care Medicine 37:10, 1575-1587
CrossRef23
Colin Sugden, Charlotte R. Housden, Rajesh Aggarwal, Barbara J. Sahakian, Ara Darzi. (2011) Effect of Pharmacological Enhancement on the Cognitive and Clinical Psychomotor Performance of Sleep-Deprived Doctors. Annals of Surgery1
CrossRef24
Pierre Brochu, Catherine Deri Armstrong, Louis-Philippe Morin. (2011) The ‘trendiness’ of sleep: an empirical investigation into the cyclical nature of sleep time. Empirical Economics
CrossRef25
Kathleen E. Walsh, Alan Picarillo. (2011) Quality Improvement Tools for Clinicians. Pediatric Annals 40:9, 454-457
CrossRef26
Linsey M. Barker, Maury A. Nussbaum. (2011) The effects of fatigue on performance in simulated nursing work. Ergonomics 54:9, 815-829
CrossRef27
Kathlyn E. Fletcher, Darcy A. Reed, Vineet M. Arora. (2011) Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules. Journal of General Internal Medicine 26:8, 907-919
CrossRef28
Vicki R. LeBlanc, Tanja Manser, Matthew B. Weinger, David Musson, Jared Kutzin, Steven K. Howard. (2011) The Study of Factors Affecting Human and Systems Performance in Healthcare Using Simulation. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 6, S24-S29
CrossRef29
Teryl K. Nuckols, José J. Escarce. (2011) Cost Implications of ACGME’s 2011 Changes to Resident Duty Hours and the Training Environment. Journal of General Internal Medicine
CrossRef30
Kalyan S. Pasupathy, Linsey M. Barker. (2011) Impact of Fatigue on Performance in Registered Nurses: Data Mining and Implications for Practice. Journal for Healthcare Qualityn/a-n/a
CrossRef31
Ioannis Kalogiannidis, Chrysoula Margioula-Siarkou, Stamatios Petousis, Michalis Goutzioulis, Nikos Prapas, Theodoros Agorastos. (2011) Infant births during the internal night are at increased risk for operative delivery and NICU admission. Archives of Gynecology and Obstetrics 284:1, 65-71
CrossRef32
Pascale Carayon, Ellen J. Bass, Tommaso Bellandi, Ayse P. Gurses, M. Susan Hallbeck, Vanina Mollo. (2011) Sociotechnical systems analysis in health care: a research agenda. IIE Transactions on Healthcare Systems Engineering 1:3, 145-160
CrossRef33
R. Moonesinghe, J. Beard. (2011) Inconclusive Findings on Effects of Duty Hour Reduction. Mayo Clinic Proceedings 86:7, 705-706
CrossRef34
Alan F. Merry, Brian J. Anderson. (2011) Medication errors - new approaches to prevention. Pediatric Anesthesia 21:7, 743-753
CrossRef35
Lana Sturm, Drew Dawson, Richard Vaughan, Peter Hewett, Andrew G. Hill, John C. Graham, Guy J. Maddern. (2011) Effects of fatigue on surgeon performance and surgical outcomes: a systematic review. ANZ Journal of Surgery 81:7-8, 502-509
CrossRef36
TONSE N.K. RAJU, GAUTHAM SURESH, ROSEMARY D. HIGGINS. (2011) Patient Safety in the Context of Neonatal Intensive Care: Research and Educational Opportunities. Pediatric Research 70:1, 109-115
CrossRef37
2011. Medical Competence and Patient Safety. , 1-32.
CrossRef38
A. Valentin. (2011) Patientensicherheit in der Intensivmedizin. Intensivmedizin und Notfallmedizin 48:3, 233-242
CrossRef39
Ann F. Minnick, Beth Donaghey, Jason Slagle, Matthew B. Weinger. (2011) Operating Room Team Members' Views of Workload, Case Difficulty, and Nonroutine Events. Journal for Healthcare Qualityno-no
CrossRef40
Darren Braude, Timothy Goldsmith, Steven J. Weiss. (2011) Assessing Air Medical Crew Real-Time Readiness to Perform Critical Tasks. Prehospital Emergency Care 15:2, 254-260
CrossRef41
Kevin R. Loughlin. (2011) Urologists on a Tightrope: Have We Lost Our Balance?. Urology 77:3, 525-532
CrossRef42
Yasuharu Tokuda, Naoki Kishida, Ryota Konishi, Shunzo Koizumi. (2011) Cognitive error as the most frequent contributory factor in cases of medical injury: A study on verdict's judgment among closed claims in Japan. Journal of Hospital Medicine 6:3, 109-114
CrossRef43
Lee Di Milia, Michael H. Smolensky, Giovanni Costa, Heidi D. Howarth, Maurice M. Ohayon, Pierre Philip. (2011) Demographic factors, fatigue, and driving accidents: An examination of the published literature. Accident Analysis & Prevention 43:2, 516-532
CrossRef44
Y. Ian Noy, William J. Horrey, Stephen M. Popkin, Simon Folkard, Heidi D. Howarth, Theodore K. Courtney. (2011) Future directions in fatigue and safety research. Accident Analysis & Prevention 43:2, 495-497
CrossRef45
Ann Williamson, David A. Lombardi, Simon Folkard, Jane Stutts, Theodore K. Courtney, Jennie L. Connor. (2011) The link between fatigue and safety. Accident Analysis & Prevention 43:2, 498-515
CrossRef46
Torbjörn ÅKERSTEDT, Göran KECKLUND. (2011) Shift Work, Severe Sleepiness and Safety. Industrial Health 49:2, 141-142
CrossRef47
Chiaki ARAKAWA, Yuka KANOYA, Chifumi SATO. (2011) Factors Contributing to Medical Errors and Incidents among Hospital Nurses —Nurses’ Health, Quality of Life, and Workplace Predict Medical Errors and Incidents—. Industrial Health 49:3, 381-388
CrossRef48
Hans P.A. Van Dongen, Steven R. Hursh. 2011. Fatigue, Performance, Errors, and Accidents. , 753-759.
CrossRef49
Erica Friedman, Reena Karani, Robert Fallar. (2011) Regulation of Medical Student Work Hours: A National Survey of Deans. Academic Medicine 86:1, 30-33
CrossRef50
Jennifer McDonald, Dipali Patel, Gregory Belenky. 2011. Sleep and Performance Monitoring in the Workplace. , 775-783.
CrossRef51
Yasushi Nakajima, Takayuki Takahashi, Masaki Yamaguchi. (2011) Diurnal variation of salivary amylase activity in fatigue state. Nihon Kyukyu Igakukai Zasshi 22:3, 117-124
CrossRef52
Kenneth B. Roberts. (2011) The Past Decade in Pediatric Education: Progress, Concerns, and Questions. Advances in Pediatrics 58:1, 123-151
CrossRef53
Meagan Parrish Meadows, Karina M. Shreffler, Stephanie N. Mullins-Sweatt. 2011. Occupational Stressors and Resilience in Critical Occupations: The Role of Personality. , 39-61.
CrossRef54
Torbjörn Åkerstedt, Pierre Philip, Aurore Capelli, Göran Kecklund. 2011. Sleep loss and accidents—Work hours, life style, and sleep pathology. , 169-188.
CrossRef55
James K. Walsh, William C. Dement, David F. Dinges. 2011. Sleep Medicine, Public Policy, and Public Health. , 716-724.
CrossRef56
Jane B Lemaire, Jean E Wallace, Kelly Dinsmore, Delia Roberts. (2011) Food for thought: an exploratory study of how physicians experience poor workplace nutrition. Nutrition Journal 10:1, 18
CrossRef57
James F. Cheeseman, Craig S. Webster, Matt D. M. Pawley, Margaret A. Francis, Guy R. Warman, Alan F. Merry. (2011) Use of a new task-relevant test to assess the effects of shift work and drug labelling formats on anesthesia trainees’ drug recognition and confirmation. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 58:1, 38-47
CrossRef58
Cathy J. Schwind, Margaret L. Boehler, Stephen J. Markwell, Reed G. Williams, Michael J. Brenner. (2011) Use of Simulated Pages to Prepare Medical Students for Internship and Improve Patient Safety. Academic Medicine 86:1, 77-84
CrossRef59
Martha Shively, Thomas Rutledge, Barbara A. Rose, Patricia Graham, Rebecca Long, Erin Stucky, Matthew B. Weinger, Timothy Dresselhaus. (2011) Real-Time Assessment of Nurse Work Environment and Stress. Journal for Healthcare Quality 33:1, 39-48
CrossRef60
Mary W. Lieh-Lai, Denise M. Goodman, Melinda Fiedor Hamilton, Kevin M. Valentine. 2011. Educating the Intensivist. , 179-189.
CrossRef61
Daniel Richard Leff, Felipe Orihuela-Espina, Thanos Athanasiou, Vahe Karimyan, Clare Elwell, John Wong, Guang-Zhong Yang, Ara W. Darzi. (2010) “Circadian Cortical Compensation”. Annals of Surgery 252:6, 1082-1090
CrossRef62
J. Collum, J. Harrop, M. Stokes, D. Kendall. (2010) Patient safety and quality of care continue to improve in NHS North West following early implementation of the European Working Time Directive. QJM 103:12, 929-940
CrossRef63
Yakov Goldich, Yaniv Barkana, Eran Pras, David Zadok, Morris Hartstein, Yair Morad. (2010) The Effects of Sleep Deprivation on Oculomotor Responses. Current Eye Research 35:12, 1135-1141
CrossRef64
Jia-Na Wang, Wei Sun, Tie-Shuang Chi, Hui Wu, Lie Wang. (2010) Prevalence and associated factors of depressive symptoms among Chinese doctors: a cross-sectional survey. International Archives of Occupational and Environmental Health 83:8, 905-911
CrossRef65
Cor J Kalkman. (2010) Handover in the perioperative care process. Current Opinion in Anaesthesiology 23:6, 749-753
CrossRef66
Landrigan, Christopher P., Parry, Gareth J., Bones, Catherine B., Hackbarth, Andrew D., Goldmann, Donald A., Sharek, Paul J., . (2010) Temporal Trends in Rates of Patient Harm Resulting from Medical Care. New England Journal of Medicine 363:22, 2124-2134
Full Text67
Raja R. Gopaldas, Danny Chu, Tam K. Dao, Joseph Huh, Scott A. LeMaire, Joseph S. Coselli, Faisal G. Bakaeen. (2010) Impact of ACGME Work-Hour Restrictions on the Outcomes of Coronary Artery Bypass Grafting in a Cohort of 600,000 Patients. Journal of Surgical Research 163:2, 201-209
CrossRef68
Andreas Valentin. (2010) The importance of risk reduction in critically ill patients. Current Opinion in Critical Care 16:5, 482-486
CrossRef69
P. Blanchard, D. Truchot, L. Albiges-Sauvin, S. Dewas, Y. Pointreau, M. Rodrigues, A. Xhaard, Y. Loriot, P. Giraud, J.C. Soria, G. Kantor. (2010) Prevalence and causes of burnout amongst oncology residents: A comprehensive nationwide cross-sectional study. European Journal of Cancer 46:15, 2708-2715
CrossRef70
James A. Gordon, Erik K. Alexander, Steven W. Lockley, Erin Flynn-Evans, Suresh K. Venkatan, Christopher P. Landrigan, Charles A. Czeisler. (2010) Does Simulator-Based Clinical Performance Correlate With Actual Hospital Behavior? The Effect of Extended Work Hours on Patient Care Provided by Medical Interns. Academic Medicine 85:10, 1583-1588
CrossRef71
Arezou Yaghoubian, Amy H. Kaji, Brandon Ishaque, Jon Park, David K. Rosing, Steven Lee, Bruce E. Stabile, Christian de Virgilio. (2010) Acute Care Surgery Performed by Sleep Deprived Residents: Are Outcomes Affected?. Journal of Surgical Research 163:2, 192-196
CrossRef72
Patricia C. Dykes, Jeffrey M. Rothschild, Ann C. Hurley. (2010) Recovered Medical Error Inventory. Journal of Nursing Scholarship 42:3, 314-318
CrossRef73
A. J. Hirsch-Allen, Najib Ayas, Scot Mountain, Peter Dodek, Adam Peets, Donald E. G. Griesdale. (2010) Influence of residency training on multiple attempts at endotracheal intubation. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 57:9, 823-829
CrossRef74
Philippa Gander, Celia Briar, Alexander Garden, Heather Purnell, Alistair Woodward. (2010) A Gender-Based Analysis of Work Patterns, Fatigue, and Work/Life Balance Among Physicians in Postgraduate Training. Academic Medicine 85:9, 1526-1536
CrossRef75
John Q. Young, Brian Niehaus, Sandra C. Lieu, Patricia S. OʼSullivan. (2010) Improving Resident Education and Patient Safety: A Method to Balance Initial Caseloads at Academic Year-End Transfer. Academic Medicine 85:9, 1418-1424
CrossRef76
Jeremy T. Cushman, Rollin J. Fairbanks, Kevin G. O’Gara, Crista N. Crittenden, Elliot C. Pennington, Matthew A. Wilson, Nancy P. Chin, Manish N. Shah. (2010) Ambulance Personnel Perceptions of Near Misses and Adverse Events in Pediatric Patients. Prehospital Emergency Care 14:4, 477-484
CrossRef77
P. Daniel Patterson, David T. Huang, Rollin J. Fairbanks, Scott Simeone, Matthew Weaver, Henry E. Wang. (2010) Variation in Emergency Medical Services Workplace Safety Culture. Prehospital Emergency Care 14:4, 448-460
CrossRef78
B. E. Lonze, A. Parsikia, E. L. Feyssa, K. Khanmoradi, V. R. Araya, R. F. Zaki, D. L. Segev, J. A. Ortiz. (2010) Operative Start Times and Complications After Liver Transplantation. American Journal of Transplantation 10:8, 1842-1849
CrossRef79
Thomas C. Neylan, Thomas J. Metzler, Clare Henn-Haase, Yelena Blank, Gary Tarasovsky, Shannon E. McCaslin, Maryann Lenoci, Charles R. Marmar. (2010) PRIOR NIGHT SLEEP DURATION IS ASSOCIATED WITH PSYCHOMOTOR VIGILANCE IN A HEALTHY SAMPLE OF POLICE ACADEMY RECRUITS. Chronobiology International 27:7, 1493-1508
CrossRef80
Nasca, Thomas J., Day, Susan H., Amis, E. Stephen Jr., . (2010) The New Recommendations on Duty Hours from the ACGME Task Force. New England Journal of Medicine 363:2,
Full Text81
Sally A. Ferguson, Matthew J. W. Thomas, Jillian Dorrian, Sarah M. Jay, Adrian Weissenfeld, Drew Dawson. (2010) WORK HOURS AND SLEEP/WAKE BEHAVIOR OF AUSTRALIAN HOSPITAL DOCTORS. Chronobiology International 27:5, 997-1012
CrossRef82
T. Michael Kashner, Steven S. Henley, Richard M. Golden, John M. Byrne, Sheri A. Keitz, Grant W. Cannon, Barbara K. Chang, Gloria J. Holland, David C. Aron, Elaine A. Muchmore, Annie Wicker, Halbert White. (2010) Studying the Effects of ACGME Duty Hours Limits on Resident Satisfaction: Results From VA Learnersʼ Perceptions Survey. Academic Medicine 85:7, 1130-1139
CrossRef83
J. F. Bion, T. Abrusci, P. Hibbert. (2010) Human factors in the management of the critically ill patient. British Journal of Anaesthesia 105:1, 26-33
CrossRef84
Matthew J. Crowley, Christina E. Barkauskas, F. Douglas Srygley, Evan P. Kransdorf, Thomas W. LeBlanc, David L. Simel, Diana B. McNeill. (2010) A Comparative Resident Site Visit Project: A Novel Approach for Implementing Programmatic Change in the Duty Hours Era. Academic Medicine 85:7, 1140-1146
CrossRef85
A. Rodenbeck, G. Hajak. (2010) Das Schichtarbeitersyndrom. Somnologie - Schlafforschung und Schlafmedizin 14:2, 105-110
CrossRef86
Sandra L. Kane-Gill, Judith Jacobi, Jeffrey M. Rothschild. (2010) Adverse drug events in intensive care units: Risk factors, impact, and the role of team care. Critical Care Medicine 38, S83-S89
CrossRef87
Tait D. Shanafelt, Charles M. Balch, Gerald Bechamps, Tom Russell, Lotte Dyrbye, Daniel Satele, Paul Collicott, Paul J. Novotny, Jeff Sloan, Julie Freischlag. (2010) Burnout and Medical Errors Among American Surgeons. Annals of Surgery 251:6, 995-1000
CrossRef88
François Lehmann, David Dunn, Ariane Murray, Jean-Pierre Pellerin. (2010) Family residents’ interventions during in-hospital call. The Clinical Teacher 7:2, 106-111
CrossRef89
&NA;. (2010) Risks of Complications by Attending Physicians After Performing Nighttime Procedures. Survey of Anesthesiology 54:3, 153-154
CrossRef90
2010. Safety Skills. , 321-340.
CrossRef91
2010. Managing the Stress and Problems of Others. , 115-124.
CrossRef92
Patricia C. Dykes, Jeffrey M. Rothschild, Ann C. Hurley. (2010) Medical Errors Recovered by Critical Care Nurses. JONA: The Journal of Nursing Administration 40:5, 241-246
CrossRef93
Gary K. Zammit, Vijay N. Joish, Meg C. Kong, Rajesh Balkrishnan, Debra Lerner, Mark Rosekind. (2010) Impact of Nighttime Awakenings on Worker Productivity and Performance. Journal of Occupational and Environmental Medicine 52:5, 513-518
CrossRef94
McMahon, Graham T., Katz, Joel T., Thorndike, Mary E., Levy, Bruce D., Loscalzo, Joseph, . (2010) Evaluation of a Redesign Initiative in an Internal-Medicine Residency. New England Journal of Medicine 362:14, 1304-1311
Full Text95
P. Daniel Patterson, Brian P. Suffoletto, Douglas F. Kupas, Matthew D. Weaver, David Hostler. (2010) Sleep Quality and Fatigue Among Prehospital Providers. Prehospital Emergency Care 14:2, 187-193
CrossRef96
Helen I. Woodward, Oliver T. Mytton, Claire Lemer, Iain E. Yardley, Benjamin M. Ellis, Paul D. Rutter, Felix E.C. Greaves, Douglas J. Noble, Edward Kelley, Albert W. Wu. (2010) What Have We Learned About Interventions to Reduce Medical Errors?. Annual Review of Public Health 31:1, 479-497
CrossRef97
Troy Madsen. (2010) News & Perspective Piece Fails to Acknowledge Evidence for Resident Work Hours Limits. Annals of Emergency Medicine 55:3, 304-305
CrossRef98
Stephen J. Swensen, C. Daniel Johnson. (2010) Flying in the Plane You Service: Patient-Centered Radiology. Journal of the American College of Radiology 7:3, 216-221
CrossRef99
Bernd Helmig, Vera Hinz, Silke Michalski, Kirstin Trotha. (2010) Zu den Auswirkungen von Arbeitszeitmodellen im ärztlichen Dienst von Krankenhäusern. Zeitschrift für Betriebswirtschaft 80:3, 263-284
CrossRef100
Kai S. Lehmann, Peter Martus, Samia Little-Elk, Heiko Maass, Christoph Holmer, Urte Zurbuchen, Georg Bretthauer, Heinz J. Buhr, Joerg P. Ritz. (2010) Impact of sleep deprivation on medium-term psychomotor and cognitive performance of surgeons: Prospective cross-over study with a virtual surgery simulator and psychometric tests. Surgery 147:2, 246-254
CrossRef101
Thomas P. Fuller, Evelyn I. Bain. (2010) Health & Safety: Shift Workers Give Sleep Short Shrift. AJN, American Journal of Nursing 110:2, 28-30
CrossRef102
Knut Forberg, Siri Waage, Bente Moen, Bjørn Bjorvatn. (2010) Subjective and objective sleep and sleepiness among tunnel workers in an extreme and isolated environment: 10-h shifts, 21-day working period, at 78 degrees north. Sleep Medicine 11:2, 185-190
CrossRef103
Julian Lim, Wen-chau Wu, Jiongjiong Wang, John A. Detre, David F. Dinges, Hengyi Rao. (2010) Imaging brain fatigue from sustained mental workload: An ASL perfusion study of the time-on-task effect. NeuroImage 49:4, 3426-3435
CrossRef104
Mayumi ARIMURA, Makoto IMAI, Masako OKAWA, Toshimasa FUJIMURA, Naoto YAMADA. (2010) Sleep, Mental Health Status, and Medical Errors among Hospital Nurses in Japan. Industrial Health 48:6, 811-817
CrossRef105
Mallory Williams, Nathanael Hevelone, Rodrigo F. Alban, James P. Hardy, David A. Oxman, Ed Garcia, Cristina Thorsen, Gyorgy Frendl, Selwyn O. Rogers. (2010) Measuring Communication in the Surgical ICU: Better Communication Equals Better Care. Journal of the American College of Surgeons 210:1, 17-22
CrossRef106
Maryann C. Deak, Robert Stickgold. (2010) Sleep and cognition. Wiley Interdisciplinary Reviews: Cognitive Sciencen/a-n/a
CrossRef107
Diane B. Boivin. (2010) Comment réduire les effets négatifs du travail de nuit sur la santé et la performance?. Gestion 35:3, 47
CrossRef108
(2009) CardioPulse Articles. European Heart Journal 30:23, 2817-2828
CrossRef109
Deborah M. DeMarco. (2009) Duty Hours. Medical Care 47:12, 1189-1190
CrossRef110
Raja R. Gopaldas, Joseph Huh, Faisal G. Bakaeen, Xing Li Wang, Joseph S. Coselli, Scott A. LeMaire, Danny Chu. (2009) The Impact of Resident Work-Hour Restrictions on Outcomes of Cardiac Operations. Journal of Surgical Research 157:2, 268-274
CrossRef111
Jeffrey H. Silber, Paul R. Rosenbaum, Amy K. Rosen, Patrick S. Romano, Kamal M. F. Itani, Liyi Cen, Lanyu Mi, Michael J. Halenar, Orit Even-Shoshan, Kevin G. Volpp. (2009) Prolonged Hospital Stay and the Resident Duty Hour Rules of 2003. Medical Care 47:12, 1191-1200
CrossRef112
Charles A. Czeisler, James K. Walsh, Keith A. Wesnes, Thomas Roth, Sanjay Arora. (2009) Armodafinil for Treatment of Excessive Sleepiness Associated With Shift Work Disorder: A Randomized Controlled Study. Mayo Clinic Proceedings 84:11, 958-972
CrossRef113
Steven H. Rose, Timothy B. Curry. (2009) Fatigue, Countermeasures, and Performance Enhancement in Resident Physicians. Mayo Clinic Proceedings 84:11, 955-957
CrossRef114
Jean E Wallace, Jane B Lemaire, William A Ghali. (2009) Physician wellness: a missing quality indicator. The Lancet 374:9702, 1714-1721
CrossRef115
Kevin G. Volpp, Amy K. Rosen, Paul R. Rosenbaum, Patrick S. Romano, Kamal M.F. Itani, Lisa Bellini, Orit Even-Shoshan, Liyi Cen, Yanli Wang, Michael J. Halenar, Jeffrey H. Silber. (2009) Did Duty Hour Reform Lead to Better Outcomes Among the Highest Risk Patients?. Journal of General Internal Medicine 24:10, 1149-1155
CrossRef116
Rachel R. Kelz, Timothy T. Tran, Patrick Hosokawa, William Henderson, E. Carter Paulson, Francis Spitz, Barton H. Hamilton, Bruce L. Hall. (2009) Time-of-Day Effects on Surgical Outcomes in the Private Sector: A Retrospective Cohort Study. Journal of the American College of Surgeons 209:4, 434-445.e2
CrossRef117
Jeffrey M. Rothschild, David W. Bates, Calvin Franz, Jane R. Soukup, Rainu Kaushal. (2009) The costs and savings associated with prevention of adverse events by critical care nurses. Journal of Critical Care 24:3, 471.e1-471.e7
CrossRef118
Pamela A. Lipsett. (2009) Resident work-hours or “duty hours”: Evidence versus emotion*. Critical Care Medicine 37:9, 2661-2662
CrossRef119
Meeta Prasad, Theodore J. Iwashyna, Jason D. Christie, Andrew A. Kramer, Jeffrey H. Silber, Kevin G. Volpp, Jeremy M. Kahn. (2009) Effect of work-hours regulations on intensive care unit mortality in United States teaching hospitals*. Critical Care Medicine 37:9, 2564-2569
CrossRef120
Pat Croskerry. (2009) A Universal Model of Diagnostic Reasoning. Academic Medicine 84:8, 1022-1028
CrossRef121
F.P. Cappuccio. (2009) 'Hospital at Night' improves outcomes: does the evidence support opinions?. QJM 102:8, 583-584
CrossRef122
Alicia R. Privette, Steven R. Shackford, Turner Osler, John Ratliff, Kennith Sartorelli, James C. Hebert. (2009) Implementation of Resident Work Hour Restrictions is Associated With a Reduction in Mortality and Provider-Related Complications on the Surgical Service. Annals of Surgery 250:2, 316-321
CrossRef123
Jeffrey B. Halldorson, Ramasamy Bakthavatsalam, Jorge D. Reyes, James D. Perkins. (2009) The impact of consecutive operations on survival after liver transplantation. Liver Transplantation 15:8, 907-914
CrossRef124
Glenn Gunzelmann, Joshua B. Gross, Kevin A. Gluck, David F. Dinges. (2009) Sleep Deprivation and Sustained Attention Performance: Integrating Mathematical and Cognitive Modeling. Cognitive Science 33:5, 880-910
CrossRef125
David W. Bates. (2009) Fatigue, Resident Work Hours, and Safety. Medical Care 47:7, 711-713
CrossRef126
Sharon A. Chung, Theresa K. Wolf, Colin M. Shapiro. (2009) Sleep and Health Consequences of Shift Work in Women. Journal of Women's Health 18:7, 965-977
CrossRef127
Amy K. Rosen, Susan A. Loveland, Patrick S. Romano, Kamal M. F. Itani, Jeffrey H. Silber, Orit O. Even-Shoshan, Michael J. Halenar, Yun Teng, Jingsan Zhu, Kevin G. Volpp. (2009) Effects of Resident Duty Hour Reform on Surgical and Procedural Patient Safety Indicators Among Hospitalized Veterans Health Administration and Medicare Patients. Medical Care 47:7, 723-731
CrossRef128
David J. Shulkin. (2009) Assessing Hospital Safety on Nights and Weekends. Journal of Patient Safety 5:2, 75-78
CrossRef129
C. Anne Morrison, Matthew M. Wyatt, Matthew M. Carrick. (2009) Impact of the 80-Hour Work Week on Mortality and Morbidity in Trauma Patients: An Analysis of the National Trauma Data Bank. Journal of Surgical Research 154:1, 157-162
CrossRef130
Michael Payette, Abhishek Chatterjee, William B. Weeks. (2009) Cost and workforce implications of subjecting all physicians to aviation industry work-hour restrictions. The American Journal of Surgery 197:6, 820-825
CrossRef131
Sarah E. McDowell, Harriet S. Ferner, Robin E. Ferner. (2009) The pathophysiology of medication errors: how and where they arise. British Journal of Clinical Pharmacology 67:6, 605-613
CrossRef132
Michael J. Englesbe, Zhaohui Fan, Onur Baser, John D. Birkmeyer. (2009) Mortality in Medicare Patients Undergoing Surgery in July in Teaching Hospitals. Annals of Surgery 249:6, 871-876
CrossRef133
Barbara J. Wilhelm, Anja Widmann, Wilhelm Durst, Christian Heine, Gerhard Otto. (2009) Objective and quantitative analysis of daytime sleepiness in physicians after night duties. International Journal of Psychophysiology 72:3, 307-313
CrossRef134
Robin E. Ferner. (2009) The epidemiology of medication errors: the methodological difficulties. British Journal of Clinical Pharmacology 67:6, 614-620
CrossRef135
Mamle Anim, Ronald J. Markert, Virginia C. Wood, Barbara L. Schuster. (2009) Physician Practice Patterns Resemble ACGME Duty Hours. The American Journal of Medicine 122:6, 587-593
CrossRef136
Blanchard, Melvin S., Meltzer, David, Polonsky, Kenneth S., . (2009) To Nap or Not to Nap? Residents' Work Hours Revisited. New England Journal of Medicine 360:21, 2242-2244
Full Text137
Nuckols, Teryl K., Bhattacharya, Jay, Wolman, Dianne Miller, Ulmer, Cheryl, Escarce, José J., . (2009) Cost Implications of Reduced Work Hours and Workloads for Resident Physicians. New England Journal of Medicine 360:21, 2202-2215
Full Text138
Amer Alshekhlee, Tobias Walbert, Michael DeGeorgia, David C. Preston, Anthony J. Furlan. (2009) The Impact of Accreditation Council for Graduate Medical Education Duty Hours, the July Phenomenon, and Hospital Teaching Status on Stroke Outcomes. Journal of Stroke and Cerebrovascular Diseases 18:3, 232-238
CrossRef139
Michael W. Tempelhof. (2009) Personal Digital Assistants: A Review of Current and Potential Utilization Among Medical Residents. Teaching and Learning in Medicine 21:2, 100-104
CrossRef140
Colleen Christmas, Roy C. Ziegelstein. (2009) The Seventh Competency. Teaching and Learning in Medicine 21:2, 159-162
CrossRef141
Haruhisa Fukuda, Yuichi Imanaka, Hiroe Kobuse, Kenshi Hayashida, Genki Murakami. (2009) The subjective incremental cost of informed consent and documentation in hospital care: a multicentre questionnaire survey in Japan. Journal of Evaluation in Clinical Practice 15:2, 234-241
CrossRef142
Mark W. Babyatsky, Hasan Bazari, John Del Valle. (2009) Response to the Institute of Medicine's Recommendations on Resident Duty Hours: The Medical Residency Program and GI Fellowship Viewpoints. Gastroenterology 136:4, 1145-1147
CrossRef143
Karl W. Thomas. (2009) Challenges, duty hours, and metrics in the intensive care unit resident rotation*. Critical Care Medicine 37:4, 1490-1492
CrossRef144
Lenny Lopez, Joel T. Katz. (2009) Perspective: Creating an Ethical Workplace: Reverberations of Resident Work Hours Reform. Academic Medicine 84:3, 315-319
CrossRef145
François Lellouche, Laurent Brochard. (2009) Advanced closed loops during mechanical ventilation (PAV, NAVA, ASV, SmartCare). Best Practice & Research Clinical Anaesthesiology 23:1, 81-93
CrossRef146
Laura K. Barger, Steven W. Lockley, Shantha M. W. Rajaratnam, Christopher P. Landrigan. (2009) Neurobehavioral, health, and safety consequences associated with shift work in safety-sensitive professions. Current Neurology and Neuroscience Reports 9:2, 155-164
CrossRef147
F. P. Cappuccio, A. Bakewell, F. M. Taggart, G. Ward, C. Ji, J. P. Sullivan, M. Edmunds, R. Pounder, C. P. Landrigan, S. W. Lockley, E. Peile, . (2009) Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison. QJM 102:4, 271-282
CrossRef148
Josef E. Fischer, Gerald B. Healy, L.D. Britt. (2009) Surgery is different: A response to the IOM report. The American Journal of Surgery 197:2, 135-136
CrossRef149
Erin R. Stucky, Timothy R. Dresselhaus, Adrian Dollarhide, Martha Shively, Gregory Maynard, Sonia Jain, Tanya Wolfson, Matthew B. Weinger, Thomas Rutledge. (2009) Intern to Attending: Assessing Stress Among Physicians. Academic Medicine 84:2, 251-257
CrossRef150
Robert J. Fortuna, Judith S. Palfrey, Steven P. Shelov, Ronald C. Samuels. (2009) Paediatric experiences with work-hour limitations. Journal of Evaluation in Clinical Practice 15:1, 116-120
CrossRef151
Shin Kon Kim. (2009) How to Save Surgical Residents in Crisis. Journal of the Korean Surgical Society 76:4, 207
CrossRef152
David Buckley, Jill Reyment, Paul Curtis. (2009) The witching time: diurnal patterns in adverse events of clinical management. Clinical Governance: An International Journal 14:4, 281-288
CrossRef153
Saumil M. Chudgar, Christopher E. Cox, Loretta G. Que, Kathryn Andolsek, Nancy W. Knudsen, Alison S. Clay. (2009) Current teaching and evaluation methods in critical care medicine: Has the Accreditation Council for Graduate Medical Education affected how we practice and teach in the intensive care unit?*. Critical Care Medicine 37:1, 49-60
CrossRef154
Robert M. Wachter. 2009. Quality of Care and Patient Safety. , 161-166.
CrossRef155
Keir Edward Lewis, Victoria Middleton Edwards, Sian Hall, Paul Temblett, Hayley Hutchings. (2009) ‘Do Not Attempt Resuscitation’ – Do Standardised Order Forms make a clinical difference above hand-written note entries?. Resuscitation 80:1, 113-119
CrossRef156
Steven L. Clark, Kathleen Rice Simpson, G. Eric Knox, Thomas J. Garite. (2009) Oxytocin: new perspectives on an old drug. American Journal of Obstetrics and Gynecology 200:1, 35.e1-35.e6
CrossRef157
Jürgen Graf, Uwe Janssens. (2009) Mengenlehre – Mengenleere?!. Wiener klinische Wochenschrift 121:1-2, 3-7
CrossRef158
2009. .
CrossRef159
John G. Hanlon, Megan A. Hayter, M. Dylan Bould, Hwan S. Joo, Viren N. Naik. (2009) Perceived sleepiness in Canadian anesthesia residents: a national survey. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 56:1, 27-34
CrossRef160
Yoo-Sam Chung. (2009) Sleep Medicine and Public Health. Korean Journal of Otorhinolaryngology-Head and Neck Surgery 52:9, 713
CrossRef161
Eran Kozer. (2009) Medication Errors in Children. Pediatric Drugs 11:1, 52-54
CrossRef162
Iglehart, John K.. (2008) Revisiting Duty-Hour Limits — IOM Recommendations for Patient Safety and Resident Education. New England Journal of Medicine 359:25, 2633-2635
Full Text163
Catherine A. McIntosh, Alex Macario. (2008) Part-Time Clinical Anesthesia Practice: a Review of the Economic, Quality, and Safety Issues. Anesthesiology Clinics 26:4, 707-727
CrossRef164
R Schonman, C De Cicco, R Corona, D Soriano, PR Koninckx. (2008) Accident analysis: factors contributing to a ureteric injury during deep endometriosis surgery. BJOG: An International Journal of Obstetrics & Gynaecology 115:13, 1611-1615
CrossRef165
Lindsay D. Friesen, Arpana R. Vidyarthi, Robert B. Baron, Patricia P. Katz. (2008) Factors Associated with Intern Fatigue. Journal of General Internal Medicine 23:12, 1981-1986
CrossRef166
Myriam J. Curet. (2008) Resident Work Hour Restrictions: Where Are We Now?. Journal of the American College of Surgeons 207:5, 767-776
CrossRef167
Lee K Brown. (2008) Physicians and sleep deprivation. Current Opinion in Pulmonary Medicine 14:6, 507-511
CrossRef168
Roy D. Ayalon, Frederick Friedman. (2008) The effect of sleep deprivation on fine motor coordination in obstetrics and gynecology residents. American Journal of Obstetrics and Gynecology 199:5, 576.e1-576.e5
CrossRef169
Michael WL Chee, Lisa YM Chuah. (2008) Functional neuroimaging insights into how sleep and sleep deprivation affect memory and cognition. Current Opinion in Neurology 24:4, 417-423
CrossRef170
Amar C. Suryadevara, Hootan Zandifar, Marci Guyer, Robert M. Kellman. (2008) Day Float: An Alternative to the Night Float Coverage System for Residency Programs. The Laryngoscope 118:7, 1257-1259
CrossRef171
Ahmad-Reza Noroozi, Rawle F. Philbert. (2008) Residents' Perception of the Impact of the Bell Commission in Oral Surgery Training: An Initial Study. Journal of Oral and Maxillofacial Surgery 66:7, 1329-1334
CrossRef172
Aaron W. Calhoun, Gordon H. Guyatt, Michael D. Cabana, Downing Lu, David A. Turner, Stacey Valentine, Adrienne G. Randolph. (2008) Addressing the Unit of Analysis in Medical Care Studies. Medical Care 46:6, 635-643
CrossRef173
Kathlyn E. Fletcher, Vikas Parekh, Lakshmi Halasyamani, Samuel R. Kaufman, Marilyn Schapira, Kristyn Ertl, Sanjay Saint. (2008) Work hour rules and contributors to patient care mistakes: A focus group study with internal medicine residents. Journal of Hospital Medicine 3:3, 228-237
CrossRef174
Ann C. Hurley, Jeffrey M. Rothschild, Mary Lou Moore, Colleen Snydeman, Patricia C. Dykes, Sofronia Fotakis. (2008) A model of recovering medical errors in the coronary care unit. Heart & Lung: The Journal of Acute and Critical Care 37:3, 219-226
CrossRef175
Joseph J. Schwerha. (2008) Occupation Medicine Forum. Journal of Occupational and Environmental Medicine 50:5, 603-605
CrossRef176
Jonathan C. Javitt, James B. Rebitzer, Lonny Reisman. (2008) Information technology and medical missteps: Evidence from a randomized trial. Journal of Health Economics 27:3, 585-602
CrossRef177
Sarah I Woodrow, Jason Park, Brian J Murray, Calvin Wang, Mark Bernstein, Richard K Reznick, Stanley J Hamstra. (2008) Differences in the perceived impact of sleep deprivation among surgical and non-surgical residents. Medical Education 42:5, 459-467
CrossRef178
Julian Lim, David F. Dinges. (2008) Sleep Deprivation and Vigilant Attention. Annals of the New York Academy of Sciences 1129:1, 305-322
CrossRef179
Michelle Janney, Christopher Landrigan. (2008) Improving nurse working conditions: Towards safer models of hospital care. Journal of Hospital Medicine 3:3, 181-183
CrossRef180
George D. Dalton, Xanthia F. Samaropoulos, Augustine C. Dalton. (2008) Improvements in the safety of patient care can help end the medical malpractice crisis in the United States. Health Policy 86:2-3, 153-162
CrossRef181
Scott E. Woods, Eric Zabat, Mary R. Talen, Stacey Bishop, Lorraine Stephens, Amy Engel. (2008) Residents' Perspective on the Impact of the 80-Hour Workweek Policy. Teaching and Learning in Medicine 20:2, 131-135
CrossRef182
Akira Ehara. (2008) Are long physician working hours harmful to patient safety?. Pediatrics International 50:2, 175-178
CrossRef183
Chi-Miao Lin, Chiang-Hsing Yang, Fung-Chang Sung, Chung-Yi Li. (2008) Risks and Causes of Hospitalizations among Physicians in Taiwan. Health Services Research 43:2, 675-692
CrossRef184
Karen S. Cosby, Rebecca Roberts, Lisa Palivos, Christopher Ross, Jeffrey Schaider, Scott Sherman, Isam Nasr, Eileen Couture, Moses Lee, Shari Schabowski, Ibrar Ahmad, R. Douglas Scott. (2008) Characteristics of Patient Care Management Problems Identified in Emergency Department Morbidity and Mortality Investigations During 15 Years. Annals of Emergency Medicine 51:3, 251-261.e1
CrossRef185
Carol A. Keohane, David W. Bates. (2008) Medication Safety. Obstetrics and Gynecology Clinics of North America 35:1, 37-52
CrossRef186
Lucian L. Leape. (2008) Scope of Problem and History of Patient Safety. Obstetrics and Gynecology Clinics of North America 35:1, 1-10
CrossRef187
Daniel R. Leff, Rajesh Aggarwal, Mariam Rana, Batool Nakhjavani, Sanjay Purkayastha, Vik Khullar, Ara W. Darzi. (2008) Laparoscopic Skills Suffer on The First Shift of Sequential Night Shifts: Program Directors Beware and Residents Prepare. Annals of Surgery 247:3, 530-539
CrossRef188
Na Zhang, Hong-Tao Liu. (2008) Effects of sleep deprivation on cognitive functions. Neuroscience Bulletin 24:1, 45-48
CrossRef189
Jürgen Graf, U. Janssens. (2008) Qualitätsmanagement in der Intensivmedizin. Intensivmedizin und Notfallmedizin 45:1, 1-11
CrossRef190
Ian Chen, Robert Vorona, Ritche Chiu, J. Catesby Ware. (2008) A Survey of Subjective Sleepiness and Consequences in Attending Physicians. Behavioral Sleep Medicine 6:1, 1-15
CrossRef191
Audrey Lyndon. (2008) Social and Environmental Conditions Creating Fluctuating Agency for Safety in Two Urban Academic Birth Centers. Journal of Obstetric, Gynecologic, & Neonatal Nursing 37:1, 13-23
CrossRef192
Thomas W. Reader, Brian H. Cuthbertson, Johan Decruyenaere. (2008) Burnout in the ICU: Potential consequences for staff and patient well-being. Intensive Care Medicine 34:1, 4-6
CrossRef193
Kazushi TAODA, Kenji NAKAMURA, Teruyo KITAHARA, Katsuo NISHIYAMA. (2008) Sleeping and Working Hours of Residents at a National University Hospital in Japan. Industrial Health 46:6, 594-600
CrossRef194
Shu-Hui Liu, Chao-Shun Wu, Yun-Lian Lin, Yu-Chen Hsiao, Chun-Yuh Yang, Fung-Chang Sung, Chung-Yi Li, Trong-Neng Wu. (2008) Lower Mortality in Male Physicians of Chinese Medicine than Male Population in Taiwan. The Tohoku Journal of Experimental Medicine 216:2, 187-194
CrossRef195
Jun-Won Hwang, Bong-Jin Hahm, Sung-Tack Kwon, Kyu-Han Kim, Jeong-Ryul Lee. (2008) Impact of lifetime subthreshold depression and major depression before internship on psychopathology and quality of life in Korean interns: 6 month follow-up study. Australian and New Zealand Journal of Psychiatry 42:4, 301-308
CrossRef196
Claire C. CARUSO, Thomas R. WATERS. (2008) A Review of Work Schedule Issues and Musculoskeletal Disorders with an Emphasis on the Healthcare Sector. Industrial Health 46:6, 523-534
CrossRef197
F. H. Morriss. (2008) Adverse Medical Events in the NICU: Epidemiology and Prevention. NeoReviews 9:1, e8-e23
CrossRef198
Melinda Fiedor Hamilton. (2008) Can we use our time more wisely?*. Pediatric Critical Care Medicine 9:1, 124-125
CrossRef199
Andreas Valentin, Julian Bion. (2007) How safe is my intensive care unit? An overview of error causation and prevention. Current Opinion in Critical Care 13:6, 697-702
CrossRef200
Christopher E Swide, Jeffrey R Kirsch. (2007) Duty hours restriction and their effect on resident education and academic departments: the American perspective. Current Opinion in Anaesthesiology 20:6, 580-584
CrossRef201
John Fanikos, Jennifer L. Cina, Steven Baroletti, Karen Fiumara, Lina Matta, Samuel Z. Goldhaber. (2007) Adverse Drug Events in Hospitalized Cardiac Patients. The American Journal of Cardiology 100:9, 1465-1469
CrossRef202
Archana Laxmisan, Forogh Hakimzada, Osman R. Sayan, Robert A. Green, Jiajie Zhang, Vimla L. Patel. (2007) The multitasking clinician: Decision-making and cognitive demand during and after team handoffs in emergency care. International Journal of Medical Informatics 76:11-12, 801-811
CrossRef203
Rainu Kaushal, David W. Bates, Calvin Franz, Jane R. Soukup, Jeffrey M. Rothschild. (2007) Costs of adverse events in intensive care units*. Critical Care Medicine 35:11, 2479-2483
CrossRef204
Nathalie Embriaco, Laurent Papazian, Nancy Kentish-Barnes, Frederic Pochard, Elie Azoulay. (2007) Burnout syndrome among critical care healthcare workers. Current Opinion in Critical Care 13:5, 482-488
CrossRef205
URBAN WIESING. (2007) ETHICAL ASPECTS OF LIMITING RESIDENTS' WORK HOURS. Bioethics 21:7, 398-405
CrossRef206
Georges Mion, Soledad Ricouard. (2007) Mortality Related to Anesthesia and Sleep Deprivation in Medical Doctors. Anesthesiology 107:3, 512
CrossRef207
H. Sax, B. Allegranzi, I. Uçkay, E. Larson, J. Boyce, D. Pittet. (2007) ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. Journal of Hospital Infection 67:1, 9-21
CrossRef208
Michel Dru, Philippe Bruge, Odile Benoit, Nicholas P. Mason, Xavier Combes, Alain Margenet, Gilles Dhonneur, Jean Marty. (2007) Overnight duty impairs behaviour, awake activity and sleep in medical doctors. European Journal of Emergency Medicine 14:4, 199-203
CrossRef209
P GLUCK. (2007) Patient safety in women's health care: a framework for progress. Best Practice & Research Clinical Obstetrics & Gynaecology 21:4, 525-536
CrossRef210
Scot A. Mountain, Bradley S. Quon, Peter Dodek, Robert Sharpe, Najib T. Ayas. (2007) The Impact of Housestaff Fatigue on Occupational and Patient Safety. Lung 185:4, 203-209
CrossRef211
Colin P. West, Rachel J. Cook, Carol Popkave, Joseph C. Kolars. (2007) Perceived Impact of Duty Hours Regulations: A Survey of Residents and Program Directors. The American Journal of Medicine 120:7, 644-648
CrossRef212
James P. Marcin. (2007) Unplanned extubations???They???re not accidental*. Pediatric Critical Care Medicine 8:4, 406-407
CrossRef213
Grace A. Lin, David C. Beck, Anita L. Stewart, Jane M. Garbutt. (2007) Resident Perceptions of the Impact of Work Hour Limitations. Journal of General Internal Medicine 22:7, 969-975
CrossRef214
J. Mellin-Olsen, E. OʼSullivan, D. Balogh, L. Drobnik, J. T. A. Knape, F. Petrini, L. Vimlati. (2007) Guidelines for safety and quality in anaesthesia practice in the European Union. European Journal of Anaesthesiology 24:6, 479-482
CrossRef215
Michael Laposata, Anand Dighe. (2007) “Pre-pre” and “post-post” analytical error: high-incidence patient safety hazards involving the clinical laboratory. Clinical Chemistry and Laboratory Medicine 45:6, 712-719
CrossRef216
T. W. Boonstra, J. F. Stins, A. Daffertshofer, P. J. Beek. (2007) Effects of sleep deprivation on neural functioning: an integrative review. Cellular and Molecular Life Sciences 64:7-8, 934-946
CrossRef217
Marc Wysocki, Josef X. Brunner. (2007) Closed-Loop Ventilation: An Emerging Standard of Care?. Critical Care Clinics 23:2, 223-240
CrossRef218
Vicki L. Montgomery. (2007) Effect of fatigue, workload, and environment on patient safety in the pediatric intensive care unit. Pediatric Critical Care Medicine 8:Suppl, S11-S16
CrossRef219
Carolyn M. Clancy. (2007) Patient Safety in the Intensive Care Unit. Journal of Patient Safety 3:1, 6-8
CrossRef220
Arpana R. Vidyarthi, Andrew D. Auerbach, Robert M. Wachter, Patricia P. Katz. (2007) The Impact of Duty Hours on Resident Self Reports of Errors. Journal of General Internal Medicine 22:2, 205-209
CrossRef221
Torbjörn Åkerstedt. (2007) Altered sleep/wake patterns and mental performance. Physiology & Behavior 90:2-3, 209-218
CrossRef222
Madelyn Azar‐Cavanagh, Pam Burdt, Judith Green‐McKenzie. (2007) Effect of the Introduction of an Engineered Sharps Injury Prevention Device on the Percutaneous Injury Rate in Healthcare Workers • . Infection Control and Hospital Epidemiology 28:2, 165-170
CrossRef223
Terry S. Field, Kathleen M. Mazor, Becky Briesacher, Kristin R. DeBellis, Jerry H. Gurwitz. (2007) Adverse Drug Events Resulting from Patient Errors in Older Adults. Journal of the American Geriatrics Society 55:2, 271-276
CrossRef224
Kevin MURPHY, Norman DELANTY. (2007) Sleep deprivation: A clinical perspective. Sleep and Biological Rhythms 5:1, 2-14
CrossRef225
B. Walder, U. Haase, I. Rundshagen. (2007) Schlafstörungen bei kritisch kranken Patienten. Der Anaesthesist 56:1, 7-17
CrossRef226
Krista Sigurdson, Najib T. Ayas. (2007) The public health and safety consequences of sleep disordersThis paper is one of a selection of papers published in this Special Issue, entitled Young Investigators' Forum.. Canadian Journal of Physiology and Pharmacology 85:1, 179-183
CrossRef227
C. A. Czeisler, J. J. Gooley. (2007) Sleep and Circadian Rhythms in Humans. Cold Spring Harbor Symposia on Quantitative Biology 72:1, 579-597
CrossRef228
Salim Surani, Shyam Subramanian, Raymond Aguillar, Maqsood Ahmed, Joseph Varon. (2007) Sleepiness in medical residents: Impact of mandated reduction in work hours. Sleep Medicine 8:1, 90-93
CrossRef229
Reidar TYSSEN. (2007) Health Problems and the Use of Health Services among Physicians: A Review Article with Particular Emphasis on Norwegian Studies. Industrial Health 45:5, 599-610
CrossRef230
David N. Fisman, Anthony D. Harris, Michael Rubin, Gary S. Sorock, Murray A. Mittleman. (2007) Fatigue Increases the Risk of Injury From Sharp Devices in Medical Trainees: Results From a Case‐Crossover Study • . Infection Control and Hospital Epidemiology 28:1, 10-17
CrossRef231
Charles W. Schauberger, Robert K. Gribble, Brenda L. Rooney. (2007) On call: a survey of Wisconsin obstetric groups. American Journal of Obstetrics and Gynecology 196:1, 39.e1-39.e4
CrossRef232
Judith Green‐McKenzie, Frances S. Shofer. (2007) Duration of Time on Shift Before Accidental Blood or Body Fluid Exposure for Housestaff, Nurses, and Technicians • . Infection Control and Hospital Epidemiology 28:1, 5-9
CrossRef233
Reshma Jagsi, Jo Shapiro, Joel S. Weissman, David J. Dorer, Debra F. Weinstein. (2006) The Educational Impact of ACGME Limits on Resident and Fellow Duty Hours: A Pre???Post Survey Study. Academic Medicine 81:12, 1059-1068
CrossRef234
Scott Lundberg, Soma Wali, Peggy Thomas, Dennis Cope. (2006) Attaining Resident Duty Hours Compliance: The Acute Care Nurse Practitioners Program at Olive View???UCLA Medical Center. Academic Medicine 81:12, 1021-1025
CrossRef235
Paul E. Ogden, Stephen Sibbitt, Martha Howell, David Rice, Jeana O???Brien, Roberto Aguirre, Peter Naus, Donald DiPette. (2006) Complying with ACGME Resident Duty Hours Restrictions: Restructuring the 80-Hour Workweek to Enhance Education and Patient Safety at Texas A&M/Scott & White Memorial Hospital. Academic Medicine 81:12, 1026-1031
CrossRef236
Jennifer R. Kogan, Roshini Pinto-Powell, Lin A. Brown, Paul Hemmer, Lisa M. Bellini, Deborah Peltier. (2006) The Impact of Resident Duty Hours Reform on the Internal Medicine Core Clerkship: Results from the Clerkship Directors in Internal Medicine Survey. Academic Medicine 81:12, 1038-1044
CrossRef237
Adam C. Urato, Sabrina D. Craigo, David Chelmow, William F. O'Brien. (2006) The association between time of birth and fetal injury resulting in death. American Journal of Obstetrics and Gynecology 195:6, 1521-1526
CrossRef238
Patrick Plunkett. (2006) Emergency Medicine in Europe ??? Time constraints may be universal, but are we seeing the same patients?. European Journal of Emergency Medicine 13:6, 321-324
CrossRef239
Jennifer S. Myers, Lisa M. Bellini, Jon B. Morris, Debra Graham, Joel Katz, John R. Potts, Charles Weiner, Kevin G. Volpp. (2006) Internal Medicine and General Surgery Residents??? Attitudes about the ACGME Duty Hours Regulations: A Multicenter Study. Academic Medicine 81:12, 1052-1058
CrossRef240
Sarah I. Woodrow, Christophe Segouin, Judith Armbruster, Stanley J. Hamstra, Brian Hodges. (2006) Duty Hours Reforms in the United States, France, and Canada: Is It Time to Refocus Our Attention on Education?. Academic Medicine 81:12, 1045-1051
CrossRef241
David E. Longnecker. (2006) Resident Duty Hours Reform: Are We There Yet?. Academic Medicine 81:12, 1017-1020
CrossRef242
Peter J Pronovost, Christine G Holzmueller, Lia Clattenburg, Sean Berenholtz, Elizabeth A Martinez, Jose Rodriguez Paz, Dale M Needham. (2006) Team care: beyond open and closed intensive care units. Current Opinion in Critical Care 12:6, 604-608
CrossRef243
Claire C. Caruso, Tim Bushnell, Donald Eggerth, Anneke Heitmann, Bill Kojola, Katharine Newman, Roger R. Rosa, Steven L. Sauter, Bryan Vila. (2006) Long working hours, safety, and health: Toward a national research agenda. American Journal of Industrial Medicine 49:11, 930-942
CrossRef244
Bryan Vila. (2006) Impact of long work hours on police officers and the communities they serve. American Journal of Industrial Medicine 49:11, 972-980
CrossRef245
Jennifer L. Bailit, Mark B. Landon, Elizabeth Thom, Dwight J. Rouse, Catherine Y. Spong, Michael W. Varner, Atef H. Moawad, Steve N. Caritis, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Mary J. O'Sullivan, Baha M. Sibai, Oded Langer. (2006) The MFMU Cesarean Registry: Impact of time of day on cesarean complications. American Journal of Obstetrics and Gynecology 195:4, 1132-1137
CrossRef246
Andreas Valentin, Maurizia Capuzzo, Bertrand Guidet, Rui P. Moreno, Lorenz Dolanski, Peter Bauer, Philipp G. H. Metnitz. (2006) Patient safety in intensive care: results from the multinational Sentinel Events Evaluation (SEE) study. Intensive Care Medicine 32:10, 1591-1598
CrossRef247
Leora I. Horwitz, Harlan M. Krumholz, Stephen J. Huot, Michael L. Green. (2006) Internal medicine residents’ clinical and didactic experiences after work hour regulation. Journal of General Internal Medicine 21:9, 961-965
CrossRef248
Edward R. Smith, William E. Butler, Fred G. Barker. (2006) Is there a “July phenomenon” in pediatric neurosurgery at teaching hospitals?. Journal of Neurosurgery: Pediatrics 105:3, 169-176
CrossRef249
Leora I. Horwitz, Harlan M. Krumholz, Stephen J. Huot, Michael L. Green. (2006) Internal Medicine Residents' Clinical and Didactic Experiences After Work Hour Regulation.. Journal of General Internal Medicine 0:0, 060721075157043-???
CrossRef250
Charles D. Gomersall, Dessmon Y. H. Tai, Shi Loo, James L. Derrick, Mia Siang Goh, Thomas A. Buckley, Catherine Chua, Ka Man Ho, Geeta P. Raghavan, Oi Man Ho, Lay Beng Lee, Gavin M. Joynt. (2006) Expanding ICU facilities in an epidemic: recommendations based on experience from the SARS epidemic in Hong Kong and Singapore. Intensive Care Medicine 32:7, 1004-1013
CrossRef251
Arpana R. Vidyarthi, Vineet Arora, Jeffrey L. Schnipper, Susan D. Wall, Robert M. Wachter. (2006) Managing discontinuity in academic medical centers: Strategies for a safe and effective resident sign-out. Journal of Hospital Medicine 1:4, 257-266
CrossRef252
Heidi L. Frankel, Andrea Foley, Calvin Norway, Lewis Kaplan. (2006) Amelioration of Increased Intensive Care Unit Service Readmission Rate after Implementation of Work-Hour Restrictions. The Journal of Trauma: Injury, Infection, and Critical Care 61:1, 116-121
CrossRef253
Mary Jo C. Grant, Amy E. Donaldson, Gitte Y. Larsen. (2006) The Safety Culture in a Childrenʼs Hospital. Journal of Nursing Care Quality 21:3, 223-229
CrossRef254
Selwyn O. Rogers, Atul A. Gawande, Mary Kwaan, Ann Louise Puopolo, Catherine Yoon, Troyen A. Brennan, David M. Studdert. (2006) Analysis of surgical errors in closed malpractice claims at 4 liability insurers. Surgery 140:1, 25-33
CrossRef255
Petra A Thürmann. (2006) Prescribing errors resulting in adverse drug events: how can they be prevented?. Expert Opinion on Drug Safety 5:4, 489-493
CrossRef256
Rahul K. Shah, David W. Roberson, Gerald B. Healy. (2006) Errors and adverse events in otolaryngology. Current Opinion in Otolaryngology & Head and Neck Surgery 14:3, 164-169
CrossRef257
Steven W Lockley, Christopher P Landrigan, Laura K Barger, Charles A Czeisler. (2006) When Policy Meets Physiology. Clinical Orthopaedics and Related Research PAP,
CrossRef258
Francis S. Nuthalapaty, Alissa R. Carver, Elizabeth S. Nuthalapaty, Patrick S. Ramsey. (2006) The perceived impact of duty hour restrictions on the residency environment: A survey of residency program directors. American Journal of Obstetrics and Gynecology 194:6, 1556-1562
CrossRef259
Russell J. Nauta. (2006) Five Uneasy Peaces: Perfect Storm Meets Professional Autonomy in Surgical Education. Journal of the American College of Surgeons 202:6, 953-966
CrossRef260
Christopher S. Parshuram, Haresh Kirpalani, Sangeeta Mehta, John Granton, Deborah Cook. (2006) In-house, overnight physician staffing: A cross-sectional survey of Canadian adult and pediatric intensive care units*. Critical Care Medicine 34:6, 1674-1678
CrossRef261
NOA AVNI, ISAAC AVNI, EREZ BARENBOIM, BELLA AZARIA, DAVID ZADOK, REUVEN KOHEN-RAZ, YAIR MORAD. (2006) Brief posturographic test as an indicator of fatigue. Psychiatry and Clinical Neurosciences 60:3, 340-346
CrossRef262
Gary E Friedlaender. (2006) The 80-hour Duty Week. Clinical Orthopaedics and Related Research PAP,
CrossRef263
Russell N. Van Gelder, Jonathan Kao. (2006) Impact of Being “On Call”. Ophthalmology 113:5, 889-890.e2
CrossRef264
Rebecca Harrison, Elizabeth Allen. (2006) Teaching Internal Medicine Residents in the New Era. Inpatient Attending with Duty-Hour Regulations. Journal of General Internal Medicine 21:5, 447-452
CrossRef265
Dennis Boyle, Daniel O???Connell, Frederic W. Platt, Richard K. Albert. (2006) Disclosing errors and adverse events in the intensive care unit*. Critical Care Medicine 34:5, 1532-1537
CrossRef266
Kenneth P. Wright, Joseph T. Hull, Rod J. Hughes, Joseph M. Ronda, Charles A. Czeisler. (2006) Sleep and Wakefulness Out of Phase with Internal Biological Time Impairs Learning in Humans. Journal of Cognitive Neuroscience 18:4, 508-521
CrossRef267
Robert O. Carpenter, Mary T. Austin, John L. Tarpley, Marie R. Griffin, Kimberly D. Lomis. (2006) Work-hour restrictions as an ethical dilemma for residents. The American Journal of Surgery 191:4, 527-532
CrossRef268
Jesús M. Aranaz, Carlos Aibar, Antonio Galán, Ramón Limón, Juana Requena, Eva Elisa Álvarez, María Teresa Gea. (2006) La asistencia sanitaria como factor de riesgo: los efectos adversos ligados a la práctica clínica. Gaceta Sanitaria 20, 41-47
CrossRef269
Susan Steinemann, Jill Omori. (2006) Use of a personal digital assistant to monitor surgery student work and sleep hours. The American Journal of Surgery 191:2, 272-275
CrossRef270
Sairam Parthasarathy. (2006) Sleep and the medical profession. Current Opinion in Internal Medicine 5:1, 62-67
CrossRef271
Michelle Gill, Paul Haerich, Kelli Westcott, Kristen L. Godenick, Jennifer A. Tucker. (2006) Cognitive Performance Following Modafinil versus Placebo in Sleep-deprived Emergency Physicians: A Double-blind Randomized Crossover Study. Academic Emergency Medicine 13:2, 158-165
CrossRef272
Chu Chen, Mattie Hardy, Jian Zhang, Gerald J. LaHoste, Nicolas G. Bazan. (2006) Altered NMDA receptor trafficking contributes to sleep deprivation-induced hippocampal synaptic and cognitive impairments. Biochemical and Biophysical Research Communications 340:2, 435-440
CrossRef273
Ilene M. Rosen, Phyllis A. Gimotty, Judy A. Shea, Lisa M. Bellini. (2006) Evolution of Sleep Quantity, Sleep Deprivation, Mood Disturbances, Empathy, and Burnout among Interns. Academic Medicine 81:1, 82-85
CrossRef274
Grace A. Lin, David C. Beck, Jane M. Garbutt. (2006) Residents?? Perceptions of the Effects of Work Hour Limitations at a Large Teaching Hospital. Academic Medicine 81:1, 63-67
CrossRef275
Steve Roey. (2006) Medical Education and the ACGME Duty Hour Requirements: Assessing the Effect of a Day Float System on Educational Activities. Teaching and Learning in Medicine 18:1, 28-34
CrossRef276
Ralph Lydic, Helen A. Baghdoyan. (2005) Sleep, Anesthesiology, and the Neurobiology of Arousal State Control. Anesthesiology 103:6, 1268-1295
CrossRef277
Eric S. Holmboe, Judith L. Bowen, Michael Green, Jessica Gregg, Lorenzo DiFrancesco, Eileen Reynolds, Patrick Alguire, David Battinelli, Catherine Lucey, Daniel Duffy. (2005) Reforming Internal Medicine Residency Training. A Report from the Society of General Internal Medicine's Task Force for Residency Reform. Journal of General Internal Medicine 20:12, 1165-1172
CrossRef278
Rebekah A. Naylor, Robert V. Rege, R. James Valentine. (2005) Do Resident Duty Hour Restrictions Reduce Technical Complications of Emergency Laparoscopic Cholecystectomy?. Journal of the American College of Surgeons 201:5, 724-731
CrossRef279
BYRON D. JOYNER, KRISTY SIEDEL, DORIS STOLL, MICHAEL MITCHELL. (2005) REPORT OF THE NATIONAL SURVEY OF UROLOGY PROGRAM DIRECTORS: ATTITUDES AND ACTIONS REGARDING THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION REGULATIONS. The Journal of Urology 174:5, 1961-1968
CrossRef280
Clifford B. Saper, Thomas E. Scammell, Jun Lu. (2005) Hypothalamic regulation of sleep and circadian rhythms. Nature 437:7063, 1257-1263
CrossRef281
Arpana Vidyarthi, Andrew Auerbach. (2005) Is 80 the Cost of Saving Lives? Reduced Duty Hours, Errors, and Cost. Journal of General Internal Medicine 20:10, 969-970
CrossRef282
Teryl K. Nuckols, Jose J. Escarce. (2005) Residency Work-Hours Reform. A Cost Analysis Including Preventable Adverse Events. Journal of General Internal Medicine 20:10, 873-878
CrossRef283
Mark A. Malangoni. (2005) President's address: Future challenges. Surgery 138:4, 547-552
CrossRef284
Brennan, Troyen A., Gawande, Atul, Thomas, Eric, Studdert, David, . (2005) Accidental Deaths, Saved Lives, and Improved Quality. New England Journal of Medicine 353:13, 1405-1409
Full Text285
Les Lang. (2005) Are 80 Hours Per Week Enough or Too Little for Residents and Fellows?. Gastroenterology 129:3, 782-783
CrossRef286
Sairam Parthasarathy. (2005) Sleep in the intensive care unit: Sleepy doctors and restless patients. Clinical Intensive Care 16:3-4, 129-136
CrossRef287
Urban Wiesing. (2005) Ethische Aspekte einer Begrenzung der ärztlichen Arbeitszeit. Ethik in der Medizin 17:3, 220-228
CrossRef288
Pere Tudela, Josep María Mòdol, María José Rego, Montserrat Bonet, Blanca Vilaseca, Jordi Tor. (2005) Error diagnóstico en urgencias: relación con el motivo de consulta, mecanismos y trascendencia clínica. Medicina Clínica 125:10, 366-370
CrossRef289
Charles Denham, James Bagian, Jennifer Daley, Susan Edgman-Levitan, Lillee Gelinas, Dennis OʼLeary, Sue Sheridan, Robert Wachter. (2005) No Excuses: The Reality That Demands Action. Journal of Patient Safety 1:3, 154-169
CrossRef290
Jeffrey M. Rothschild, Christopher P. Landrigan, John W. Cronin, Rainu Kaushal, Steven W. Lockley, Elisabeth Burdick, Peter H. Stone, Craig M. Lilly, Joel T. Katz, Charles A. Czeisler, David W. Bates. (2005) The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care*. Critical Care Medicine 33:8, 1694-1700
CrossRef291
Patrick Gerbeaux. (2005) Should emergency medical service rescuers be trained to practice endotracheal intubation?*. Critical Care Medicine 33:8, 1864-1865
CrossRef292
Jeffrey B. Gould, Cheng Qin, Gilberto Chavez. (2005) Time of Birth and the Risk of Neonatal Death. Obstetrics & Gynecology 106:2, 352-358
CrossRef293
Reshma Jagsi, Jo Shapiro, Debra F. Weinstein. (2005) Perceived Impact of Resident Work Hour Limitations on Medical Student Clerkships: A Survey Study. Academic Medicine 80:8, 752-757
CrossRef294
Jennifer L. Irani, Michelle M. Mello, Stanley W. Ashley, Edward E. Whang, Michael J. Zinner, Elizabeth Breen. (2005) Surgical residents' perceptions of the effects of the ACGME duty hour requirements 1 year after implementation. Surgery 138:2, 246-253
CrossRef295
Josef E. Fischer. (2005) Surgeons: employees or professionals?. The American Journal of Surgery 190:1, 1-3
CrossRef296
Kaiser G. Lim, William F. Dunn, Kyle W. Klarich, Bekele Afessa. (2005) Internal medicine resident education in the medical intensive care unit: The impact on education and patient care of a scheduling change for didactic sessions*. Critical Care Medicine 33:7, 1534-1537
CrossRef297
Peter I. Ellman, Irving L. Kron, Jeffrey S. Alvis, Carlos Tache-Leon, Thomas S. Maxey, T. Brett Reece, Benjamin B. Peeler, John A. Kern, Curtis G. Tribble. (2005) Acute Sleep Deprivation in the Thoracic Surgical Resident Does Not Affect Operative Outcomes. The Annals of Thoracic Surgery 80:1, 60-65
CrossRef298
Christiane Corriveau, John T. Berger. (2005) Strategic learning: Linking resident training to outcomes for patients*. Critical Care Medicine 33:7, 1655-1656
CrossRef299
Benjamin K. Poulose, Wayne A. Ray, Patrick G. Arbogast, Jack Needleman, Peter I. Buerhaus, Marie R. Griffin, Naji N. Abumrad, R Daniel Beauchamp, Michael D. Holzman. (2005) Resident Work Hour Limits and Patient Safety. Annals of Surgery 241:6, 847-860
CrossRef300
Russell G. Foster, Katharina Wulff. (2005) Science and society: The rhythm of rest and excess. Nature Reviews Neuroscience 6:5, 407-414
CrossRef301
R. R. Grunstein, N. L. Rogers. (2005) Medical work hours: time for a Maggie's Law for doctoring?. Internal Medicine Journal 35:5, 269-271
CrossRef302
(2005) Post-Call Accidents. New England Journal of Medicine 352:14, 1491-1492
Full Text303
Joseph D Kronz, William H Westra. (2005) The role of second opinion pathology in the management of lesions of the head and neck. Current Opinion in Otolaryngology & Head and Neck Surgery 13:2, 81-84
CrossRef304
(2005) Interns' Work Hours. New England Journal of Medicine 352:7, 726-728
Full Text305
Barger, Laura K., Cade, Brian E., Ayas, Najib T., Cronin, John W., Rosner, Bernard, Speizer, Frank E., Czeisler, Charles A., . (2005) Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns. New England Journal of Medicine 352:2, 125-134
Full Text306
James K. Walsh, William C. Dement, David F. Dinges. 2005. Sleep Medicine, Public Policy, and Public Health. , 648-656.
CrossRef307
Altman, Drew E., Clancy, Carolyn, Blendon, Robert J., . (2004) Improving Patient Safety — Five Years after the IOM Report. New England Journal of Medicine 351:20, 2041-2043
Full Text308
Mukherjee, Siddhartha, . (2004) A Precarious Exchange. New England Journal of Medicine 351:18, 1822-1824
Full Text309
Ofri, Danielle, . (2004) Residency Regulations — Resisting Our Reflexes. New England Journal of Medicine 351:18, 1824-1826
Full Text310
Lockley, Steven W., Cronin, John W., Evans, Erin E., Cade, Brian E., Lee, Clark J., Landrigan, Christopher P., Rothschild, Jeffrey M., Katz, Joel T., Lilly, Craig M., Stone, Peter H., Aeschbach, Daniel, Czeisler, Charles A., . (2004) Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures. New England Journal of Medicine 351:18, 1829-1837
Full Text311
Drazen, Jeffrey M., . (2004) Awake and Informed. New England Journal of Medicine 351:18, 1884-1884
Full Text
- Letters
