Hospitals in pursuit of excellence

Waking Up to Safety: Nurse Work Hours and Patient Safety

The link between excessive work hours and adverse errors is inseparable. This project investigated if work hour guidelines and education had an impact on nurse work hours, fatigue management and patient outcomes. New hospital guidelines proposed employees do not work more than three, 12-hour shifts in a row or more than 50-hours per pay period. An education program described the research behind these guidelines and included personal and professional countermeasures to prevent fatigue. Data obtained from surveys and various reports examined fatigue countermeasure use, actual work hours, adverse events, and quality outcomes. Following implementation, schedules and payroll reports demonstrated a decrease in nurses working greater than three, 12-hour shifts in a row or more than 50 hours in a pay period. The number of reported adverse events did not significantly change. However, there was an increase in total countermeasure use and improved quality measures. The fundamental role of patient safety teams is to learn from failures and create an environment of action. This project demonstrates action.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state.  These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)