Table 3.

Studies of patient safety and quality of care

Source	Study Design	Population and Setting	Intervention Type	Study Outcomes	Study Quality
Afessa30	Retrospective, “before and after” controlled trial	Internal medicine residents and 626 patients in a MICU at a single hospital	Transition from Q3 call to a 14-h work-shift model	No difference in MICU or in-hospital mortality or length of stay.	Level II-3
Bhavsar40	Retrospective, “before and after” controlled trial	Internal medicine residents and 1,003 patients admitted to the cardiology service at a single hospital	Elimination of extended shifts for senior residents on the cardiology service (no change for interns)	Improved adherence to ACS guidelines, decreased length of stay; no change in hospital mortality but improvement in 6 month mortality.	Level II-3
de Virgilio34	Retrospective, “before and after” controlled trial	Surgical residents and 11,518 trauma patients treated at a single Level 1 Trauma Center	Decrease in call frequency from an average of once every 4.8 days to once every 6.4 days	No change in complication rate or mortality rate for trauma patients.	Level II-3
Goldstein26	Prospective, “before and after” controlled trial	Surgical residents and surgical patients treated at a single hospital	Transition from Q4 call to a night float system with 12- to 14-h shifts	Improvement in Press-Ganey scores for Surgery Department and quality of care delivered by residents as rated by nurses.	Level II-3
Gottlieb42	Prospective, “before and after” controlled trial	Internal medicine residents and 1,103 patients admitted to a single VA medical center	Transition from a Q4 call schedule to schedule with maximum 16 hour shifts	Decrease in patient length of stay and medication errors with shift work schedule.	Level II-3
Horwitz41	Retrospective, controlled trial with both concurrent and historical controls	Internal medicine residents and 20,924 medicine patients admitted to a single hospital	Elimination of extended shifts for residents (no change for interns)	Decrease in ICU admission and decrease in pharmacist intervention to prevent drug errors after intervention.	Level II-1
Hutter25	Prospective, “before and after” controlled trial	Surgical residents and 3,976 surgical patients treated at a single Level 1 Trauma Center	Reduction in call frequency from Q3 to Q4	No change in complication or mortality rates for surgical cases.	Level II-3
Landrigan19	Prospective, randomized controlled trial	Internal medicine interns and 634 MICU/CCU patients admitted to a single hospital	Comparison of Q3 traditional call schedule with 30-h shifts to system with maximum 16-h shifts	Decrease in serious medical errors made by interns with shift work system compared to Q3 call schedule.	Level I
Malangoni36	Prospective, “before and after” controlled trial	PGY4/5 surgical residents and 3,100 trauma/emergency surgery patients admitted to a single Level 1 Trauma Center	50% reduction in call shifts per month per resident	Decrease in mortality for trauma and emergency surgical patients.	Level II-3
Mann43	Prospective, “before and after” controlled trial	Radiology residents and 26,421 emergency radiology cases reviewed at a single hospital	Elimination of extended shifts for radiology residents via implementation of dedicated night shifts	Decrease in frequency of mis-read films requiring patient call back to the Emergency Department.	Level II-3
Sawyer24	Prospective, concurrent controlled trial	Surgical interns at a single hospital	Comparison of interns on Q2, Q3, and Q4 schedules	No difference in number of errors per call shift.	Level II-1