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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Are long physician working hours harmful to patient safety?

A Ehara.

Review published: 2008.

Link to full article: [Journal publisher]

CRD summary

This review found that decrease of physician work hours was not harmful but favourable to patient safety. As there were a number of methodological shortcomings these conclusions should be interpreted with caution.

Authors' objectives

To investigate the effect of long physician working hours on patient safety.

Searching

MEDLINE and EMBASE were searched from 1966 to August 2005 for English- and Japanese-language studies. Search terms were reported.

Study selection

Studies that described the relationship between physician work hours and patient safety and reported outcomes directly related to patient safety (such as rates of complications, medical errors and misdiagnosis) were eligible for inclusion.

The number of hours worked by physicians varied between included studies. Outcomes reported were: complications, malpractice, post-partum haemorrhage, neonatal resuscitations, accidents/injuries and misdiagnosis.

The author did not state how many reviewers selected studies for inclusion.

Assessment of study quality

Methodological quality was broadly assessed. Criteria for assessment and number of reviewers performing validity assessment were not reported,

Data extraction

Data were extracted for patient safety outcomes. The number of reviewers that extracted data was not reported.

Methods of synthesis

The studies were synthesised narratively.

Results of the review

Seven studies were included in the review (n not reported): one prospective randomised study; one prospective self-controlled trial; two prospective cohort studies; two retrospective cohort studies; and one was a descriptive study.

Four studies reported that residents with shorter hours made fewer medical errors. Three studies found that reducing hours did not decrease the occurrence of unfavourable outcomes. None of the studies reported that shorter working hours were harmful to patient safety.

Authors' conclusions

Decrease of physician work hours is not harmful but favourable to patient safety.

CRD commentary

The review question was defined in terms of intervention, outcomes and participants. Only two databases were searched in two languages and unpublished studies were not sought, so language and publication biases could not be ruled out. The review process was not described, so any steps taken to minimise reviewer error and bias were unknown. It did not appear that study quality was assessed in a systematic way; therefore, this was difficult to interpret. Narrative synthesis appeared appropriate given the differences between studies.

As there were a number of methodological shortcomings the author's conclusions should be interpreted with caution.

Implications of the review for practice and research

Practice: The author did not state any implications for practice.

Research: The author stated that there should be further investigation to find the best balance of physician workload and continuity of patient care.

Funding

Not stated.

Bibliographic details

Ehara A. Are long physician working hours harmful to patient safety? Pediatrics International 2008; 50(2): 175-178. [PubMed: 18353054]

Indexing Status

Subject indexing assigned by NLM

MeSH

Humans; Medical Errors; Pediatrics /organization & administration; Personnel Staffing and Scheduling; Safety; Workload

AccessionNumber

12008104563

Database entry date

09/02/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 18353054