Impact of resident duty hour limits on safety in the intensive care unit: a national survey of pediatric and neonatal intensivists

Pediatr Crit Care Med. 2012 Sep;13(5):578-82. doi: 10.1097/PCC.0b013e318241785c.


Objective: Resident duty-hour regulations potentially shift the workload from resident to attending physicians. We sought to understand how current or future regulatory changes might impact safety in academic pediatric and neonatal intensive care units.

Design: Web-based survey.

Setting: U.S. academic pediatric and neonatal intensive care units.

Subjects: Attending pediatric and neonatal intensivists.

Interventions: We evaluated perceptions on four intensive care unit safety-related risk measures potentially affected by current duty-hour regulations: 1) attending physician and resident fatigue; 2) attending physician workload; 3) errors (self-reported rates by attending physicians or perceived resident error rates); and 4) safety culture. We also evaluated perceptions of how these risks would change with further duty-hour restrictions.

Measurements and main results: We administered our survey between February and April 2010 to 688 eligible physicians, of whom 360 (52.3%) responded. Most believed that resident error rates were unchanged or worse (91.9%) and safety culture was unchanged or worse (84.4%) with current duty-hour regulations. Of respondents, 61.9% believed their own work-hours providing direct patient care increased and 55.8% believed they were more fatigued while providing direct patient care. Most (85.3%) perceived no increase in their own error rates currently, but in the scenario of further reduction in resident duty-hours, over half (53.3%) believed that safety culture would worsen and a significant proportion (40.3%) believed that their own error rates would increase.

Conclusions: Pediatric intensivists do not perceive improved patient safety from current resident duty-hour restrictions. Policies to further restrict resident duty-hours should consider unintended consequences of worsening certain aspects of intensive care unit safety.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel*
  • Fatigue / psychology
  • Fellowships and Scholarships / organization & administration
  • Female
  • Health Care Surveys
  • Hospitalists / organization & administration
  • Humans
  • Intensive Care Units, Neonatal / organization & administration
  • Intensive Care Units, Neonatal / standards*
  • Internship and Residency / organization & administration
  • Logistic Models
  • Male
  • Medical Errors*
  • Multivariate Analysis
  • Organizational Culture
  • Patient Safety
  • Personnel Staffing and Scheduling / organization & administration
  • Personnel Staffing and Scheduling / standards*
  • Physicians / psychology*
  • Statistics, Nonparametric
  • United States
  • Work Schedule Tolerance / physiology
  • Work Schedule Tolerance / psychology
  • Workload