The DOI matches its Crossref record; 52 of the 52 references it cites were found in a registry or an index.
Effects of Reducing or Eliminating Resident Work Shifts over 16 Hours: A Systematic Review
Open accessAbstract
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 DESIGN AND OUTCOME MEASURES: We performed a systematic review of published and unpublished studies (1950-2008) to synthesize data on all intervention studies that have reduced or eliminated U.S. residents' extended shifts.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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“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.”
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“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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Cites
Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units
Landrigan, C. P., Rothschild, J. M., Cronin, J. W., Kaushal, R., Burdick, E., Katz, J. T., Lilly, C. M., Stone, P. H., Lockley, S. W., Bates, D. W., et al. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa041406 · Cited by 1,760
Self-citationCurrent methods of the U.S. Preventive Services Task Force
Harris, R., Helfand, M., Woolf, S. H., Lohr, K. N., Mulrow, C. D., Teutsch, S. M., & Atkins, D. C. (2001) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(01)00261-6 · Cited by 1,720
Effects of Sleep Deprivation on Performance: A Meta-Analysis
Pilcher, J. J., & Huffcutt, A. I. (1996) · Sleep · doi:10.1093/sleep/19.4.318 · Cited by 1,549
Fatigue, alcohol and performance impairment
Dawson, D., & Reid, K. (1997) · Nature · doi:10.1038/40775 · Cited by 1,199
Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns
Barger, L. K., Cade, B. E., Ayas, N. T., Cronin, J. W., Rosner, B., Speizer, F. E., & Czeisler, C. A. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa041401 · Cited by 928
Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures
Lockley, S. W., Cronin, J. W., Evans, E. E., Cade, B. E., Lee, C. J., Landrigan, C. P., Rothschild, J. M., Katz, J. T., Lilly, C. M., Stone, P. H., et al. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa041404 · Cited by 913
Self-citationAccreditation Council on Graduate Medical Education (ACGME)
Rovner, J. (2009) · Health Care Policy and Politics A to Z · doi:10.4135/9781452240121.n6 · Cited by 671
Does Housestaff Discontinuity of Care Increase the Risk for Preventable Adverse Events?
Petersen, L. A., Brennan, T. A., O'Neil, A. C., Cook, E. F., & Lee, T. H. (1994) · Annals of Internal Medicine · doi:10.7326/0003-4819-121-11-199412010-00008 · Cited by 665
New Requirements for Resident Duty Hours
Philibert, I. (2002) · JAMA · doi:10.1001/jama.288.9.1112 · Cited by 531
Resident Duty Hours: Enhancing Sleep, Supervision, and Safety
Ulmer, C. C., Wolman, D. M., & Johns, M. M. E. (2009) · Cited by 481
Research works printed but not linked: 5
- Development of safe resident work hours legislation, 2008, Sleep Research Society
- 2006, Principles regarding resident and student work hours
- 2007, Summary of actions, 31st interim business meeting
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- 2006, Internal medicine residents' sleepiness during different call conditions, 29
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Resident physicians’ advice seeking and error making: A social networks approach
Katz‐Navon, T., & Naveh, E. (2022) · Health Care Management Review · doi:10.1097/hmr.0000000000000333
Editorial. Is the grass greener with night float?
Yun, J. J., & Jane, J. A. (2022) · Journal of neurosurgery · doi:10.3171/2022.6.jns22768
Jiménez-Ceballos, B., Arana-Lechuga, Y., Terán-Pérez, G., Escartín-Pérez, R. E., & Velázquez‐Moctezuma, J. (2023) · Neuroscience & Medicine · doi:10.4236/nm.2023.143004
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Bif, S. M., Sales, C. R., Bif, R. M., Barroso, P. H., Almeida, R., Rangel, E., Perini, G. L. M., Pichek, G. V., Lopes, G. K., & Borges, C. R. (2024) · Revista fisio&terapia. · doi:10.69849/revistaft/ni10202408152103
Cacheiro, A., Cadish, L. A., Zayed, A. M., Chang, J., & Lane, F. L. (2025) · Journal of surgical education · doi:10.1016/j.jsurg.2025.103828
The impact of sleep on resident clinical reasoning: a scoping review
Capaldi, V. F., Aidara, Y., Flores, B., Dupont, J., Kim, E., Simonelli, G., Durning, S. J., & Jung, E. (2026) · Diagnosis · doi:10.1515/dx-2026-0024
田中, 彩., Nagino, K., Iwagami, M., Midorikawa‐Inomata, A., Takahashi, K., Yamaji, K., Arai, H., Nishizaki, Y., Inomata, T., & Kobayashi, H. (2026) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2026.106724
Metadata
- Authors
- Levine, A. C., Adusumilli, J., & Landrigan, C. P.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- 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
- 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 › Nursing › Leadership and Management › 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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