The Effect of Residents’ Working-Hour Restrictions on Patient Safety, Resident Well-Being, and Resident Education: Protocol for a Systematic Review and Meta-Analysis

ABSTRACT Introduction Residents’ duty hour restrictions have been a source of debate throughout the years, given that extended shifts have historically been associated with a negative effect on patient safety. Implementing restricted duty hours may help reduce sleep deprivation and workload, consequently improving residents’ sense of well-being. On the other hand, these reforms implicate a greater number of handoffs where communication errors may arise, and continuity of care being lost as a result. In a similar way, shorter shifts may implicate less time of direct patient contact and, consequently, decreased educational opportunities for residents. Various studies have attempted to explore the effect of resident work hour reforms on patient safety outcomes. However, these have been mainly based solely on observational studies that have not been subjected to the same rigor as experimental ones, primarily because no randomized controlled trials (RCT) were available in this matter. Nonetheless, more substantial evidence has become available in these last few years as three RCTs have been published exploring the impact of resident duty hour restrictions on patient safety as well as on residents’ wellbeing and education. An updated systematic review and meta-analysis are crucial to interpret this data that has now become available. Objectives To evaluate the effect of resident physicians’ working-hour restrictions on patient safety parameters, residents’ perceived well-being and resident education. Methods and analysis This research protocol was developed according to PRISMA-P and the Cochrane guidelines for systematic reviews and metanalysis. Electronic literature search strategies were developed using MeSH and free terms to be carried out in PubMed, MEDLINE, EMBASE, Cochrane Library, Clinicaltrials.gov and Global Index Medicus with no restriction in language. Primary outcome measures include several patient safety parameters, whereas secondary outcome measures involve resident well-being and education. Two research team members will screen identified titles, abstract and full text, evaluate risk of bias and extract data in an independent manner. A qualitative narrative synthesis will be employed to summarize the key findings, population, and methodology of studies using text and tables for both primary and secondary outcomes. We will test for heterogeneity of the included studies by employing the I 2 statistical test; if significant (I 2 ≥ 75%), only qualitative synthesis will be presented. On the contrary, if studies are homogeneous, a meta-analysis will be considered using Review Manager 5.1 software. For continuous data, we will calculate the mean difference or standardized mean difference. For dichotomous data, the risk ratio (RR) will be calculated. Results will be displayed on a Forest Plot. To assess bias, a Funnel plot and Egger test will be employed. Conclusions This systematic review will provide evidence regarding the effect of resident physicians’ working-hour restrictions on patient safety parameters, residents’ perceived well-being and resident education. All of these are variables that must be considered when determining policies regarding the medical training environment. It is essential to review the existing high-grade evidence regarding the impact of residents’ extended working hours so that authorities can optimize future graduate medical education regulations.