K Award Grantee Interview: Christopher Landrigan, M.D., M.P.H.
The following is a transcript of grantee responses to the following questions:
- What is the primary focus of your research?
- How has funding from AHRQ helped to advance your research?
- Why did you choose to focus on this topic?
- How has your AHRQ funding helped you help other health services researchers?
Chris Landrigan: So the primary focus of my research is patient safety—trying to understand what drivers in the health care system are responsible for the epidemic of medical errors and adverse events that we’ve been experiencing in this country for the past several decades.
Funding from AHRQ is really what launched me on my current career path. So at the tail end of my training, I was interested in a general way in the quality of the health care system but was not exactly sure where I was going to go with that. And then, as I was a fellow, in 1999, the Institute of Medicine’s landmark report, To Err Is Human, came out, which really I think galvanized at a national level the patient safety movement. For me personally, within a couple of years of that report coming out, a lot of my research activities had shifted over to investigating the ways that we measure patient safety and try and understand the nature of the epidemic in this country. And that sort of led to conversations with a whole host of folks who were interested in patient safety problems and, ultimately, to my applying for a K Award with AHRQ to develop myself as a patient safety investigator and, in particular, to try to understand the relationship between doctors’ sleep deprivation and patient safety, which was a big interest of mine at the time and still is.
I began developing an interest in patient safety really during my own training. And, in particular, on the issue of sleep deprivation and patient safety was really affected by some experiences I had myself as a pediatric resident physician, where I was sleep deprived and knew that I was not operating at my best in the middle of the night when a crisis would come up or the following day when I had to take care of critical activities. And that personal feeling of vulnerability under those circumstances really came together with the national patient safety movement and with AHRQ’s push to try to better understand some of the drivers of human performance failure. I applied with my mentor at the time to study sleep deprivation and its effects on patient safety through an AHRQ award and applied for a K Award at more or less the same time to develop my own interest in this area and expertise both in patient safety as well as an understanding of sleep deprivation and circadian misalignment and how those things had a bearing on sleep deprivation.
One of my earliest pieces of work funded by AHRQ was to conduct a randomized-control trial into intensive care units at Brigham and Women's Hospital, where we looked at what happened when we eliminated shifts exceeding 16 hours for the interns, the first-year resident physicians in those units. And we found that when we did that, the rates of serious medical errors dropped off very significantly. This was published in the New England Journal of Medicine at the time and for me was really a launching point of my career, thinking about both sleep deprivation as well as a lot of the other factors in our microsystems that affect the way that doctors and nurses work and what impact that has on patient safety.
Over the years, AHRQ has funded me at several critical points in my career trying to develop various aspects of an interest in patient safety and sleep deprivation. Over the past 10 years or so, I’ve become particularly interested in the issue of handoffs and communications between physicians and nurses and what impact that has on patient safety. Particularly, as we began to accumulate data that sleep deprivation really was a pretty universal problem leading to medical errors in intensive care units, operating rooms, and in other settings, my colleagues and I began to develop a series of interventions to try to reduce hours. But one of the barriers that we faced in doing that was that we were having shorter shifts that led inevitably to more transitions of care between doctors working shorter shifts. And as we began to drill down into that a little bit, it became clear that those transitions were themselves problematic and a source of patient safety problems.
And so much of my work over the past 10 years has been mentoring a series of investigators who've become increasingly interested in that problem, and together we have worked to design safer handoff systems of care, in particular a program called I-PASS that has now been tested in multicenter studies in pediatrics, and we’re moving beyond that now to test it in other specialties and in nursing as well.