Fewer Work Hours for Medical Trainees - More Mistakes.

Time article link

Doctors & Nurses


Fewer Hours for Doctors-in-Training Leading To More Mistakes

By Alexandra SifferlinMarch 26, 20130





MARTIN BARRAUD / GETTY IMAGES/OJO IMAGES RF

Giving residents less time on duty and more time to sleep was supposed to lead to fewer medical errors. But the latest research shows that’s not the case. What’s going on?

Since 2011, new regulations restricting the number of continuous hours first-year residents spend on-call cut the time that trainees spend at the hospital during a typical duty session from 24 hours to 16 hours. Excessively long shifts, studies showed, were leading to fatigue and stress that hampered not just the learning process, but the care these doctors provided to patients.

And there were tragic examples of the high cost of this exhausting schedule. In 1984, 18-year old Libby Zion, who was admitted to a New York City hospital with a fever and convulsions, was treated by residents who ordered opiates and restraints when she became agitated and uncooperative. Busy overseeing other patients, the residents didn’t evaluate Zion again until hours later, by which time her fever has soared to 107 degrees and she went into cardiac arrest, and died. The case highlighted the enormous pressures on doctors-in-training, and the need for reform in the way residents were taught. In 1987, a New York state commission limited the number of hours that doctors could train in the hospital to 80 each week, which was less than the 100 hour a week shifts with 36 hour “call” times that were the norm at the time. In 2003, the Accreditation Council for Graduate Medical Education followed suit with rules for all programs that mandated that trainees could work no more than 24 consecutive hours.

(MORE: Should Your Doctor Be Napping on the Job?)

In 2011, those hours were cut even further, but the latest data, published online in JAMA Internal Medicine, found that interns working under the new rules are reporting more mistakes, not enough sleep and symptoms of depression. In the study that involved 2,300 doctors from more than a dozen national hospitals the researchers compared a population of interns serving before the 2011 work hour limit was implemented, to interns working after the new rule, during a three-month period. The former group were on-call every fourth night, for a maximum of 30 hours, while the latter group worked no more than 16 hours during any one shift. They gathered self-reported data from on their duty hours, sleep hours, symptoms of depression, well-being and medical errors at three, six, nine and 12 months into their first year of residency.

Read more: http://healthland.time.com/2013/03/26/fewer-hours-for-doctors-in-training-leading-to-more-mistakes/#ixzz2OeP7W4A2