Work like a Doc: a comparison of regulations on residents' working hours in 14 high-income countries

Background: Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents’ work hours. Objectives: We aimed to review residents’ work hours regulations in different countries with an emphasis on night shifts. Methods: Standardized qualitative data on residents’ working hours were collected with the assistance of experts from 14 high-income countries through a questionnaire. An international comparative analysis was performed. Results: All countries reviewed limit the weekly working hours; North-American countries limit to 60–80 h, European countries limit to 48 h. In most countries, residents work 24 or 26 consecutive hours, but the number of long overnight shifts varies, ranging from two to ten. Many European countries face difficulties in complying with the weekly hour limit and allow opt-out contracts to exceed it. Conclusions: In the countries analyzed, residents still work long hours. Attempts to limit the shift length or the weekly working hours resulted in modest improvements in residents’ quality of life with mixed effects on quality of care and residents’ education

The role of public health nurses in the detection of developmental dysplasia of the hip

Aims  Our study aimed to quantify the role played by public health nurses (PHNs) in the detection of cases of developmental dysplasia of the hip (DDH) not identified by existing national screening processes.  Methods  We conducted a review of all children diagnosed with DDH in our centre over an 18-month period. Referral details and general clinical information were then analysed for all late diagnoses, defined as later than three months of age.  Results  339 infants were diagnosed with at least some degree of dysplasia over the study period, implying an annual incidence of 31.3 cases per 1,000 live births. 86 of these (25.4%) were late diagnoses. 67.9% of referrals of late cases originated with a PHN. A small subgroup of late diagnoses (n = 8) presented with frank hip dislocation.  Conclusion  The proportion of DDH diagnoses made after three months of age remains significant. Our findings suggest that PHN reviews in the first year of life constitute an important ‘safety net’ in expediting the diagnosis of DDH in babies not identified by existing national screening processes. Quality improvement and training interventions would be of value in further supporting this role.</p