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Sleep Deprivation, Health Care Providers, and Patient Safety

Posted By Administration, Friday, February 17, 2017

Fatigue can compromise the safety of patients and the health care workforce.

by Joanna Carmona

Landrigan, MD, MPH


Medical residents working shifts of 24 hours or more make 36% more serious medical errors than those who are limited to working 16 consecutive hours, according to a 2004 study published in the New England Journal of Medicine.

Even with patient and physician safety in jeopardy over sleep deprivation and fatigue, there’s still much debate over reducing trainees’ hours. Some of the objection to duty hour limits comes from the idea that trainees need to work extra hours in order to gain clinical experience and that shorter shifts may cause harm due to the increased handoffs required.

To Christopher P. Landrigan, MD, MPH, research director of the Inpatient Pediatrics Service at Boston Children’s Hospital, director of the Sleep and Patient Safety Program at Brigham and Women’s Hospital, and associate professor of pediatrics and medicine at Harvard Medical School, however, the misunderstanding of this key issue is the jumping off point to start discussion and change.

In a 2013 interview in PSNet, Dr. Landrigan said that “the trick is to implement changes in work hours in concert with concentrated efforts to improve the handoff process, teamwork, and infrastructure. Doing so can address fatigue-related errors without necessarily leading to a substantial increase in handoff errors. The net result can indeed be one where fatigue-related errors are reduced and handoff errors are not increased either.”


Dr. Landrigan has a wealth of experience on this topic and is the featured speaker for the National Patient Safety Foundation’s next Professional Learning Series Webcast, Sleep Deprivation, Health Care Providers, and Patient Safety, on February 27, 2017. He has led numerous landmark studies on the epidemiology of medical errors and adverse events, and interventions designed to reduce their incidence. His most important work has been focused on developing reliable patient safety measurement tools, and improving the organization of residency programs and academic medical centers. Dr. Landrigan’s work has contributed to national changes in resident work hour standards.

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) created a set of requirements stating that duty periods of PGY-1 (Post Graduate Year One) residents must not exceed 16 hours in duration. Most recently, however, ACGME is in the midst of a re-review of the requirements with the intention of deciding whether or not to revert these requirements, allowing PGY-1 residents to take on 28-hour shifts like their more senior colleagues.

We know that when restrictions on shift hours are put in place, residents report that their quality of life improves and the rate of serious medical errors is reduced. We’ll discuss this and much more on the relationship between health care provider work hours, sleep deprivation, and patient safety. Please join us for this timely discussion.


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Joanna Carmona is communications coordinator at the National Patient Safety Foundation. Contact her at

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Tags:  fatigue  medical education 

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