A delicate balance: physician work hours, patient safety, and organizational efficiency.

The Accreditation Council for Graduate Medical Education (ACGME) recognized the importance of housestaff in the provision of hospital care when it regulated housestaff duty hours to improve patient safety. ACGME intended to create a better balance between the management of resident fatigue and the continuity of patient care, but the shorter hours mandated by duty hour reform have created more frequent patient handoffs, which may interfere with the continuity of care.1–4 Concern about handoffs and recent work examining how outcomes vary in accordance with organizational factors such as the level of staffing on weekends have bought renewed attention to the issues of the effect of organizational factors in care delivery on outcomes and the efficiency of patient care.5,6 Two articles, one in Circulation and one in Circulation: Heart Failure, provide information about these concerns.