Christopher P Landrigan

Christopher P Landrigan
Boston Children's Hospital ·  Division of General Pediatrics

MD, MPH

About

219
Publications
33,856
Reads
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16,449
Citations
Citations since 2017
82 Research Items
6839 Citations
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Introduction
Christopher Landrigan is Chief of General Pediatrics at Boston Children’s Hospital, Director of the Sleep and Patient Safety Program at Brigham and Women's Hospital, and the William Berenberg Professor of Pediatrics at Harvard Medical School. In addition, he was the founding chair and is currently an Executive Council Member of the Pediatric Research in Inpatient Settings (PRIS) Network, a collaboration of over 100 pediatric hospitals that has conducted a series of major multi-center research and improvement projects; and was a founding member of the Harvard Work Hours, Health, and Safety Group. He studies patient safety, sleep deprivation, handoffs of care, and communication in hospitals.
Additional affiliations
October 2007 - July 2016
The University of Warwick
Position
  • Honorary Associate Professor
July 2002 - July 2016
Harvard Medical School
Position
  • Professor (Associate)
January 2001 - present
Brigham and Women's Hospital
Position
  • Director, Sleep and Patient Safety Program

Publications

Publications (219)
Article
Study objectives: Sleep deficiency can adversely affect the performance of resident physicians resulting in greater medical errors. However, the impact of sleep deficiency on surgical outcomes, particularly among attending surgeons is less clear. Methods: Sixty attending surgeons from academic and community departments of surgery or obstetrics a...
Article
Background: Handoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. However, implementation across specialties has not been assessed. Objective: To determine if I-PASS implementation across diverse settin...
Article
Full-text available
Background Methods of sustaining the deimplementation of overused medical practices (i.e., practices not supported by evidence) are understudied. In pediatric hospital medicine, continuous pulse oximetry monitoring of children with the common viral respiratory illness bronchiolitis is recommended only under specific circumstances. Three national gu...
Article
Background: Variation exists in family-centered rounds (FCR). Objective: We sought to understand patient/family and clinician FCR beliefs/attitudes and practices to support implementation efforts. Designs, settings and participants: Patients/families and clinicians at 21 geographically diverse US community/academic pediatric teaching hospitals...
Article
Introduction: Patient and family-centered rounds (PFCRs) are an important element of family-centered care often used in the inpatient pediatric setting. However, techniques and best practices vary, and faculty, trainees, nurses, and advanced care providers may not receive formal education in strategies that specifically enhance communication on PF...
Preprint
Background: Sleep deficiency can adversely affect the performance of resident physicians resulting in greater medical errors. However, the impact of sleep deficiency on surgical outcomes, particularly among attending surgeons is less clear. Methods: Sixty attending surgeons from academic and community departments of surgery or obstetrics and gyneco...
Article
Full-text available
Background Effective communication in transitions between healthcare team members is associated with improved patient safety and experience through a clinically meaningful reduction in serious safety events. Family-centered rounds (FCR) can serve a critical role in interprofessional and patient-family communication. Despite widespread support, FCRs...
Article
Background and objectives: Hospitalized children with medical complexity (CMC) are at high risk of medical errors. Their families are an underutilized source of hospital safety data. We evaluated safety concerns from families of hospitalized CMC and patient/parent characteristics associated with family safety concerns. Methods: We conducted a 12...
Article
Importance: Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness. Objective: To examine disparities in reported hospital safety climate by language proficie...
Article
BACKGROUND AND OBJECTIVES Despite compelling evidence that patients and families report valid and unique safety information, particularly for children with medical complexity (CMC), hospitals typically do not proactively solicit patient or family concerns about patient safety. We sought to understand parent, staff, and hospital leader perspectives...
Article
Full-text available
Background: The Accreditation Council for Graduate Medical Education (ACGME) enacted a policy in 2011 that restricted first-year resident physicians in the USA to work no more than 16 consecutive hours. This was rescinded in 2017. Methods: We conducted a nationwide prospective cohort study of resident physicians for 5 academic years (2002-2007)...
Article
Light exposure at night impedes sleep and shifts the circadian clock. An extensive body of literature has linked sleep deprivation and circadian misalignment with cardiac disease, cancer, mental health disorders, and other chronic illnesses, as well as more immediate risks, such as motor vehicle crashes and occupational injuries. In the current iss...
Article
Background: The services of Healthcare and Social Assistance (HCSA) workers are needed by society around the clock. As a result, these workers are exposed to shift work and long work hours. The combination of demanding work schedules and other hazards in the HCSA work environment increases the health and safety risks to these workers, as well as t...
Article
Background: The Joint Commission has identified miscommunication as a leading cause of sentinel events, the most serious adverse events, but it is unclear what role miscommunications play in malpractice claims. We sought to determine the proportion of medical malpractice claims involving communication failure and describe their nature, including p...
Article
OBJECTIVES Increased focus on health care quality and safety has generally led to additional resident supervision by attending physicians. At our children’s hospital, residents place orders overnight that are not explicitly reviewed by attending physicians until morning rounds. We aimed to categorize the types of orders that are added or discontinu...
Article
Importance: National guidelines recommend against continuous pulse oximetry use for hospitalized children with bronchiolitis who are not receiving supplemental oxygen, yet guideline-discordant use remains high. Objectives: To evaluate deimplementation outcomes of educational outreach and audit and feedback strategies aiming to reduce guideline-d...
Article
Full-text available
Abstract Background The COVID-19 pandemic resulted in disruptions to medical school training and the transition to residency for new post-graduate year 1 resident-physicians (PGY1s). Therefore, the aim of this study was to understand the perspectives of United States PGY1s regarding the impact of the pandemic on these experiences. Our secondary aim...
Article
Objectives: Extended-duration work rosters (EDWRs) with shifts of 24+ hours impair performance compared with rapid cycling work rosters (RCWRs) that limit shifts to 16 hours in postgraduate year (PGY) 1 resident-physicians. We examined the impact of a RCWR on PGY 2 and PGY 3 resident-physicians. Methods: Data from 294 resident-physicians were an...
Article
Background: Pediatric Hospital Medicine (PHM) was approved as a subspecialty in 2016. Perspectives of pediatric and combined pediatric residents regarding barriers and facilitators to pursuing PHM fellowships have not previously been assessed. Methods: A survey to explore residents' perspectives on PHM fellowships, with questions regarding demog...
Article
Objective: Continuous pulse oximetry monitoring (cSpO2) in children with bronchiolitis does not improve clinical outcomes and has been associated with increased resource use and alarm fatigue. It is critical to understand the factors that contribute to cSpO2 overuse in order to reduce overuse and its associated harms. Methods: This multicenter q...
Article
The accuracy of pulse oximetry monitor orders for identifying infants with bronchiolitis who are being continuously monitored is unknown. In this 56-hospital repeated cross-sectional study, investigators used direct bedside observation to determine continuous pulse oximetry monitor use and then assessed if an active continuous monitoring order was...
Article
Continuous pulse oximetry monitoring in stable patients with bronchiolitis is discouraged by national guidelines in order to reduce overuse, yet wide practice variation exists among hospitals. Understanding the association between monitoring overuse and hospital unit-level factors may identify areas for improvement. Conducted at 25 sites from the P...
Article
Background Fatigue-related errors that occur during patient care impose a tremendous socioeconomic impact on the health care system. Blue-enriched light has been shown to promote alertness and attention. The present study tested whether blue-enriched light can help to reduce medical errors in a university hospital adult ICU. Methods In this interv...
Article
Importance Children of parents expressing limited comfort with English (LCE) or limited English proficiency may be at increased risk of adverse events (harms due to medical care). No prior studies have examined, in a multicenter fashion, the association between language comfort or language proficiency and systematically, actively collected adverse...
Article
Full-text available
Background The effects on patient safety of eliminating extended-duration work shifts for resident physicians remain controversial. Methods We conducted a multicenter, cluster-randomized, crossover trial comparing two schedules for pediatric resident physicians during their intensive care unit (ICU) rotations: extended-duration work schedules that...
Article
Full-text available
Objectives: Residents are often assigned online learning materials as part of blended learning models, superimposed on other patient care and learning demands. Data that describe the time patterns of when residents interact with online learning materials during the ICU rotation are lacking. We describe resident engagement with assigned online curr...
Article
Introduction: The I-PASS Handoff Program is a comprehensive handoff curriculum that has been shown to decrease rates of medical errors and adverse events during patient handoffs. Frontline providers are the key individuals participating in handoffs of patient care. It is important they receive robust handoff training. Methods: The I-PASS Mentore...
Article
Importance US national guidelines discourage the use of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis who do not require supplemental oxygen. Objective Measure continuous pulse oximetry use in children with bronchiolitis. Design, Setting, and Participants A multicenter cross-sectional study was performed in pedi...
Article
Background: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-h limit on consecutive hours for first-year resident physicians. We sought to examine the effect of these work-hour regulations on physician safety. Methods: All medical students matched to a United States residency program from 2002-2007 and 20...
Article
Full-text available
Objective The risk of medical errors increases upon transfer out of the intensive care unit (ICU). Discrepancies in the documented care plan between notes at the time of transfer may contribute to communication errors. We sought to determine the frequency of clinically meaningful discrepancies in the documented care plan for patients transferred fr...
Article
Background An increased focus on quality and safety has resulted in increased resident supervision by attending physicians. At our large pediatric academic medical center, the overnight shift is when residents admit general pediatrics patients without immediate attending supervision. As such, admission orders are not evaluated by an attending until...
Article
Full-text available
Study Objectives We compared resident physician work hours and sleep in a multi-center clustered-randomized crossover clinical trial that randomized resident physicians to an Extended Duration Work Roster (EDWR) with extended-duration (≥24 hours) shifts or a Rapidly Cycling Work Roster (RCWR), in which scheduled shift lengths were limited to 16 or...
Article
Full-text available
Background Deimplementation, the systematic elimination of low-value practices, has emerged as an important focus within implementation science. Bronchiolitis is the leading cause of infant hospitalization. Among stable inpatients with bronchiolitis who do not require supplemental oxygen, continuous pulse oximetry monitoring is recognized as an ove...
Article
Full-text available
Direct observation of clinical skills is central to assessment in a competency-based medical education model, yet little is known about how direct observation is experienced by trainees and observers. The objective of the study is to explore how direct observation was experienced by residents and faculty in the context of the I-PASS Handoff Study....
Article
Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliab...
Article
Full-text available
Introduction First year postgraduate (PGY1) resident physicians have impaired vigilance and more attentional failures working extended duration work rosters (EDWR) with 24+ hour extended-duration shifts compared to shifts scheduled to 16 or fewer hours. We examined the impact of a rapid cycling work roster (RCWR) intervention designed to limit cont...
Article
Introduction Extended duration work shifts in resident-physicians may impact safety and performance, but the relative benefits and harms of eliminating extended duration shifts is uncertain. Methods We conducted a multi-center, cluster-randomized crossover trial in pediatric Intensive Care Units (ICUs) at 6 academic medical centers to compare two...
Article
Introduction Extended-duration work shifts (≥ 24 hours), the cornerstone of medical education, have been associated with reduced sleep first-year resident physicians in a single-site study. We compared more senior resident physician work hours and sleep habits in a multi-center clustered-randomized crossover clinical trial that randomized resident...
Article
Introduction Mathematical models of neurobehavioral performance are a key tool in work schedule assessment, allowing quantitative predictions of performance, especially in cases where empirical assessment would be impractical. Models have recently been extended to predict accurately the effects of chronic sleep restriction on vigilant performance,...
Article
Introduction Resident-physicians’ extended duration work shifts impair their safety and performance, but the effects on patient safety of eliminating them remain unclear. Methods We carried out a 6-center cluster-randomized trial comparing rates of serious medical errors (SMEs) when resident-physicians worked on an extended duration work roster (E...
Article
Introduction Long work hours and extended-duration (≥24 hours) work shifts are associated with higher risks of motor vehicle crashes (MVCs), near-crashes, percutaneous injuries (PIs), medical errors, and adverse events among resident physicians in their first postgraduate year (PGY1). We sought to determine if these same associations were present i...
Article
Purpose: To determine whether higher rates of medical errors were associated with positive screenings for depression or burnout among resident physicians. Method: The authors conducted a prospective cohort study from 2011-2013 in seven pediatric academic medical centers in the United States and Canada. Resident physicians were screened for burno...
Article
Introduction: While the Accreditation Council for Graduate Medical Education limited first year resident-physicians to 16 consecutive work hours from 2011 to 2017, resident-physicians in their second year or higher were permitted to work up to 28 h consecutively. This paper describes the Randomized Order Safety Trial Evaluating Resident-physician...
Article
Objectives: Previous studies have revealed racial/ethnic and socioeconomic disparities in quality of care and patient safety. However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). In this study, we do so using the Global Assessment of Pediatric Patien...
Article
Full-text available
Objective To determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds. Design Prospective, multicenter before and after intervention study. Setting Pediatric inpatient units in...
Article
Full-text available
Introduction Communication failures during shift-to-shift handoffs of patient care have been identified as a leading cause of adverse events in health care institutions. The I-PASS Handoff Program is a comprehensive handoff program that has been shown to decrease rates of medical errors and adverse events. As part of the spread and adaptation of th...
Data
A. SHM I-PASS Mentored Implementation Guide.pdf B. SHM I-PASS Mentored Implementation Guide.docx C. I-PASS Training Materials Tips and Tricks.docx D. I-PASS Handoff Program Implementation Steps.docx
Article
Background: Miscommunication during patient transfers is a leading cause of medical errors. Inpatient standardization of handoff communication has been associated with reduced medical errors, but less is known about best practices for handoffs from referring providers to the emergency department (ED). The study aims were to identify (1) stakeholde...
Article
Full-text available
Background Behavior change is notoriously difficult to achieve within health care systems. Successful implementation of the I-PASS handoff bundle with subsequent decreases in medical errors and preventable adverse events represents an example of successful transformational change within academic medical centers. Objective We designed a campaign to...
Article
Full-text available
: media-1vid110.1542/5789657761001PEDS-VA_2017-3360Video Abstract BACKGROUND: Patient safety concerns over the past 2 decades have prompted widespread efforts to reduce adverse events (AEs). It is unclear whether these efforts have resulted in reductions in hospital-wide AE rates. We used a validated safety surveillance tool, the Global Assessment...
Article
Importance While the relationship between resident work hours and patient safety has been extensively studied, little research has evaluated the role of attending physician supervision on patient safety. Objective To determine the effect of increased attending physician supervision on an inpatient resident general medical service on patient safety...
Article
Full-text available
Introduction To improve patient safety, the Centers for Medicare & Medicaid Services (CMS) has promoted systematically measuring and reporting harm due to patient care. The CMS’s Partnership for Patients program identified 9 hospital-acquired conditions (HACs) for reduction, to make care safer, more reliable, and less costly. However, the proportio...
Article
Introduction In 2011, the Accreditation Council for Graduate Medical Education instituted a 16-hour limit on the number of consecutive hours that first-year resident physicians (PGY1 physicians) may be scheduled to work. We sought to examine the effect of these duty hour regulations on patient and physician safety. Methods All graduating medical s...
Article
Objectives: Broad-spectrum antibiotics are commonly used for the empiric treatment of acute hematogenous osteomyelitis and often target methicillin-resistantStaphylococcus aureus(MRSA) with medication-associated risk and unknown treatment benefit. We aimed to compare clinical outcomes among patients with osteomyelitis who did and did not receive i...
Article
Objectives: The Association of American Medical Colleges published a list of entrustable professional activities (EPAs) that graduating medical students should be able to perform on day 1 of residency without direct supervision. We sought to explore the perceptions of residents and pediatric hospitalists about the level of supervision new interns...
Article
Objectives: Depression and burnout are highly prevalent among residents, but little is known about modifiable personality variables-such as resilience and stress from uncertainty-that may predispose to these conditions. Residents are routinely faced with uncertainty when making medical decisions. We sought to determine how stress from uncertainty...
Article
Full-text available
Introduction The I-PASS Handoff Program is a comprehensive handoff curriculum that has been shown to decrease rates of medical errors and adverse events during patient handoffs. I-PASS champions are a critical part of the implementation and sustainment of this curriculum, and therefore, a rigorous program to support their training is necessary. Me...
Article
Background: Miscommunications lead to medical errors and suboptimal hospital experience. Parent-provider miscommunications are understudied. Objectives: (1) Examine characteristics of parent-provider miscommunications about hospitalized children, (2) describe associations among parent-provider miscommunications, parent-reported errors, and hospi...
Article
Background and objective Handoff communication errors are a leading source of sentinel events. We sought to determine the impact of a handoff improvement programme for nurses. Methods We conducted a prospective pre-post intervention study on a paediatric intensive care unit in 2011–2012. The I-PASS Nursing Handoff Bundle intervention consisted of...
Article
Background In 2009 the I-PASS Study Group was formed by patient safety, medical education, health services research, and clinical experts from multiple institutions in the United States and Canada. When the I-PASS Handoff Program, which was developed by the I-PASS Study Group, was implemented in nine hospitals, it was associated with a 30% reductio...
Article
Introduction In 2011, the Accreditation Council for Graduate Medical Education instituted a 16-hour limit on the number of consecutive hours that resident physicians may be scheduled to work in their first postgraduate year. We sought to examine the effect of these work hour limitations on resident safety, patient safety, and resident education. M...
Article
Introduction Adverse safety outcomes are associated with extended-duration (≥ 24 hour) shifts worked by resident physicians. In 2011 the Accreditation Council for Graduate Medical Education (ACGME) implemented an 80-hour work week (averaged over 4 weeks) and a 16-hour limit on the number of consecutive hours that resident physicians may be schedule...
Article
Introduction Little is known about how policies enacted in 2011 by the Accreditation Council for Graduate Medical Education (ACGME), which limited the number of extended-duration shifts for first-year medical residents, have affected the lifestyle of resident physicians in the United States. We sought to test whether measures of sleep, health, and...
Article
Full-text available
Background: The I-PASS Handoff Study found that introduction of a handoff bundle (handoff and teamwork training for residents, a mnemonic, a handoff tool, a faculty development program, and a sustainability campaign) at 9 pediatrics residency programs was associated with improved communication and patient safety. Objective: This parallel qualita...
Article
Objectives: To define hospital factors associated with proportion of time spent by pediatric residents in direct patient care. Methods: We assessed 6222 hours of time-motion observations from a representative sample of 483 pediatric-resident physicians delivering inpatient care across 9 pediatric institutions. The primary outcome was percentage...
Article
Objective: Despite widespread adoption of in-house call for ICU attendings, there is a paucity of research on optimal scheduling of intensivists to provide continuous on-site coverage. Overnight call duties have traditionally been added onto 7 days of continuous daytime clinical service. We designed an alternative ICU staffing model to increase co...
Article
Full-text available
Importance: Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism...
Article
Objective: To assess parent and provider experience and shared understanding after a family-centered, multidisciplinary nighttime communication intervention (nurse-physician brief, family huddle, family update sheet). Methods: Prospective intervention study at a children's hospital from 5/2013-10/2013 (pre-intervention) and 5/2014-10/2014 (post-...
Article
Background Handoff miscommunications are a leading source of medical errors. Error rates decreased following implementation of the I-PASS handoff program (a bundled intervention using a structured mnemonic, I-PASS, and other initiatives to sustain implementation) in a pediatric research trial. Whether I-PASS can be implemented in settings outside a...