Are Shorter Shifts for Medical Residents Improving Patient Safety?

 

In California and throughout the rest of the United States, it has long been an accepted fact that medical residents work very long hours and are often overworked. The residency period is seen as a rite of passage, something that the residents have to live through in order to learn the skills to save lives and to enter the lucrative and rewarding field of medicine.

“Over time, the rules for medical residents have changed as it has become clear that working endless shifts can prove detrimental to patient care,” explains California injury lawyer James Ballidis.

A recent article in The Wall Street Journal took a look at some of the changes in the policies related to resident hours and discussed the pros and cons of limiting the number of hours worked.

According to the article in The Wall Street Journal, there was no limit on the number of hours that a medical resident could work prior to 2003. The author of the article, a doctor himself, indicated that he had worked numerous 36-hour shifts as a resident and that he had fallen asleep when driving home from work on multiple occasions due to his exhaustion.

When a person lacks sleep, his or her abilities and faculties are impaired by fatigue. In fact, going 17 hours without sleep can result in a person being just as impaired as a person with a blood alcohol content of .05, and going 24 hours without sleep is as impairing as having a BAC of .10, above the legal limit to drive.

In recognition of the dangers of a resident practicing medicine with no sleep, the Accreditation Council for Graduate Medical Education took action in 2003 and limited residents to working no more than 80 hours per week. This Accreditation Council is in charge of approving all U.S. physician training programs, so their decision essentially established a new industry-wide standard.

In 2010, the council went even further and prohibited first-year residents from working overnight shifts lasting 24 hours. This, too, was an attempt to stop sleep-deprived residents from providing medical care to patients.

The change in the rules was an important one with the goal of making patients safer. As many as 200,000 people die each year as a result of medical errors, and a doctor who has not had any sleep is much more likely to make an error than a well rested physician.

Should Hours Be Further Limited?

While the new limits are an important step towards protecting patient safety, the United States still allows residents to work many more hours per week than other parts of the world. For example, in Europe, the standard number of hours worked by medical residents is set at 48 hours per week. This means that U.S. residents still work almost twice as many hours as those in Europe.

Yet, further limits on the number of hours worked could also have the effect of compromising patient care. As The Wall Street Journal article points out, fewer hours worked by a resident means less experience providing care, performing medical procedures, encountering different patient situations and learning new skills. This could result in the resident being less equipped to care for patients once the residency program ends.

Another immediate problem is that patients may suffer when a shift change occurs. The author of the article, who is a patient safety expert and chief of medical services at an academic teaching hospital, indicates that the current limitations on shift time often result in patients being handed off as many as three or four times within a 24-hour period. At each handoff, essential information is lost and the new doctor may not know as much about the patient’s condition. Patients could even be lost in the change, and there could be a delay in the patients getting the care that they need.

One problem has been traded for another and thus patients may not be any safer. Instead of being treated by a fatigued doctor, they may be receiving treatment from a doctor who isn’t fully informed about their current medical situation.

The problem of resident hours may still not be solved. The decision on the number of hours worked must be made carefully by taking the risks and benefits of limiting hours into account and trying to find a reasonable balance.

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