Effects of reducing or eliminating resident work shifts over 16 hours: a systematic review

Levine, Adam C.; Adusumilli, Josna; Landrigan, Christopher P.

doi:10.1093/sleep/33.8.1043

Cited by 108Hospital Admissions and OutcomesSleep and Work-Related FatigueHealthcare professionals’ stress and burnout

Effects of reducing or eliminating resident work shifts over 16 hours: a systematic review

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Levine, Adam C., Adusumilli, Josna, Landrigan, Christopher P.·2010·Sleep

DOI 10.1093/sleep/33.8.1043PMC PMC2910534

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Abstract

STUDY OBJECTIVES: The Institute of Medicine (IOM) has called for the elimination of resident work shifts exceeding 16 hours without sleep. We sought to comprehensively evaluate the effects of eliminating or reducing shifts over 16 hours. DESIGN AND OUTCOME MEASURES: We performed a systematic review of published and unpublished studies (1950-2008) to synthesize data on all intervention studies that have reduced or eliminated U.S. residents' extended shifts. A total of 2,984 citations were identified initially, which were independently reviewed by two authors to determine their eligibility for inclusion. All outcomes relevant to quality of life, education, and safety were collected. Study quality was rated using the U.S. Preventive Services Task Force methodology. MEASUREMENTS AND RESULTS: Twenty-three studies met inclusion criteria (kappa = 0.88 [95% CI, 0.77-0.94] for inclusion decisions). Following reduction or elimination of extended shifts, 8 of 8 studies measuring resident quality of life found improvements. Four of 14 studies that assessed educational outcomes found improvements, 9 found no significant changes, and one found education worsened. Seven of 11 identified statistically significant improvements in patient safety or quality of care; no studies found that safety or care quality worsened. CONCLUSIONS: In a systematic review, we found that reduction or elimination of resident work shifts exceeding 16 hours did not adversely affect resident education, and was associated with improvements in patient safety and resident quality of life in most studies. Further multi-center studies are needed to substantiate these findings, and definitively measure the effects of eliminating extended shifts on patient outcomes.

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A body of evidence accumulated suggesting that reducing or eliminating shifts longer than 16 hours did not negatively impact resident education and likely improved patient safety and resident quality of life.
“Altogether, a body of evidence accumulated suggesting that reducing or eliminating shifts longer than 16 hours did not negatively impact resident education and likely improved patient safety and resident quality of life.”
From National improvements in resident physician-reported patient safety after limiting first-year resident physicians’ extended duration work shifts: a pooled analysis of prospective cohort studies (2023) · cites this paper as [8]
Sleep deprivation increases the risk of performance failures and medical errors.
“although sleep depriva-tion increases the risk of performance failures and medical errors, 27,[35][36][37]”
From Changes in medical errors after implementation of a handoff program (2014) · cites this paper as [27]

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Authors: Levine, A. C., Adusumilli, J., & Landrigan, C. P.
Affiliations: Brigham and Women's Hospital (US)
Corresponding author: Landrigan, Christopher P.
ORCID: Levine, Adam C.
Landrigan, Christopher P.
Venue: Sleep
Publisher: Oxford University Press (OUP)
Published: 2010-08
Volume: 33
Issue: 8
Pages: 1043-1053
ISSN: 0161-8105 (ISSN-L)
1550-9109
DOI: 10.1093/sleep/33.8.1043
PMC: PMC2910534
OpenAlex: W1574902429
Cited by: 108
References: 51
Citations by year: 2026: 4 · 2025: 7 · 2024: 4 · 2023: 3 · 2022: 9 · 2021: 5 · 2020: 6 · 2019: 4 · 2018: 5 · 2017: 6 · 2016: 7 · 2015: 4 · 2014: 13 · 2013: 12 · 2012: 11
FWCI: 1.77
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: SLEEP (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Brigham and Women's Hospital
Massachusetts General Hospital
Topics: Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
Keywords: resident work hours, medical residents, resident quality of life, resident education, patient safety, quality of care, sleep deprivation, IOM recommendations
MeSH terms: Achievement, Humans, Internship and Residency, Quality of Health Care, Quality of Life, Safety, Work Schedule Tolerance

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Effects of reducing or eliminating resident work shifts over 16 hours: a systematic review

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