Resident doctors still work too long: report

WASHINGTON Fri Jun 24, 2011 12:24am EDT

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WASHINGTON (Reuters) - First-year residents may soon get a reprieve from grueling hospital shifts that last more than 24 hours, but that is not enough to prevent an alarming number of medical errors, according to a report released on Friday.

Starting July 1, new rules will require first-year residents to work shifts no longer than 16 straight hours. But that will not spare more experienced residents from working as long as 28 hours at a stretch.

A group of 26 doctors and patient safety experts are calling for limiting all resident physician work to shifts of 12 to 16 hours. Their report was published on Friday in the journal Nature & Science of Sleep journal.

"What started as a good system has evolved into a system where the residents are extremely sleep deprived, caring for some of the sickest patients in the country, and that's a set-up for disaster," Dr. Christopher Landrigan, one of the report's authors, said in an interview.

The report is the product of a conference held last year at Harvard Medical School. It also recommends that residents should be subject to increased supervision by attending physicians and hand off routine work like blood draws or paperwork to other staff.

The group cited U.S. government statistics that show as many as 180,000 patients each year die due to harm resulting from their medical care.

The new resident work rules are based on recommendations from the Institute of Medicine, which estimated implementation would cost $1.7 billion, mostly to hire additional hospital staff. Landrigan said the costs would be offset by reducing medical errors.

"Few people enter a hospital expecting that their care and safety are in the hands of someone who has been working a double-shift or more with no sleep," said Dr. Lucian Leape, adjunct professor of health policy at the Harvard School of Public Health and a co-author of the report.

"If they knew, and had a choice, the overwhelming majority would demand another doctor or leave," he said in a statement.

The Accreditation Council for Graduate Medical Education (ACGME), the body that oversees residency training, issued the new rules for first-years in September 2010. It has said it was committed to examining resident hours "with a goal of making them better."

Landrigan said he does not expect the report to change the rules for other residents anytime soon, because of tradition and costs.

(Reporting by Andrew Seaman; Editing by Michele Gershberg)

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Comments (1)
Masshysteria wrote:
Interestingly, there has been no data presented as to whether there has actually been a decrease in errors as a result of reductions to the current 80-hour limitation from the grueling hours that residents used to work prior to the current limitations. Data appears to show that there are still the same number of errors. The data are difficult to mine; many errors may not be directly attributable to the residents, and it is difficult to know if resident errors are strictly due to fatigue. What is true is that the reduction in work hours nearly 10 years ago has resulted in increased numbers of handoffs as residents go off and on “shifts”. Does this contribute to increased errors? It is possible that the increased numbers of handoffs, and errors that may be associated, may cancel out a benefit acquired by forced further reduction of resident work hours. Although methods of controlling fatigue by limiting work hours are well-intended, they may be skirting the problem (or creating new problems) rather than solving the problem.

Jun 25, 2011 10:21am EDT  --  Report as abuse
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