June 24, 2011
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.
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.
‘A set-up for disaster’
Landrigan said the costs would be offset by reducing medical errors.
“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.
Their report was published on Friday in the journal Nature & Science of Sleep journal.
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.
“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.
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