We need to continue to find simple, practical, and effective strategies that hospitals and senior doctors can take to reduce sleep deprivation among residents. We also need to continue to study this issue in other types of residents.

Our study, like others before it, does raise concerns about the performance of sleep deprived physicians-in-training and suggests that strategies aimed at reducing fatigue-related impairments are likely necessary.

This adds to the growing evidence that sleep deprivation among medical residents significantly impairs their ability to perform, although it is important to note that we did not assess performance on specific medical tasks.

Hospitals are busy places, and doctors are fallible, and things will fall through the cracks, and they'll fall through the cracks a lot.

We found that success involved much more than skilled individual doctors and nurses. What distinguished these hospitals was how well they were organized, how teams functioned together, how the culture rewarded quality improvement and how they dealt with setbacks.

Several of our doctors who were assisting patients on the Coast have come back and told us to be prepared.