Delinking resident duty hours from patient safety

Roisin Osborne, Christopher S Parshuram

Patient safety is a powerful motivating force for change in modern medicine, and is often cited as a rationale for reducing resident duty hours. However, current data suggest that resident duty hours are not significantly linked to important patient outcomes. We performed a narrative review and identified four potential explanations for these findings. First, we question the relevance of resident fatigue in the creation of harmful errors. Second, we discuss factors, including workload, experience, and individual characteristics, that may be more important determinants of resident fatigue than are duty hours. Third, we describe potential adverse effects that may arise from - and, therefore, counterbalance any potential benefits of - duty hour reductions. Fourth, we explore factors that may mitigate any risks to patient safety associated with using the services of resident trainees.