Report Prescribes Limiting Medical Residents’ Workday

The Institute of Medicine recommended last week that medical residents work no more than 16 hours at a stretch, with more time off for sleep between shifts, in order to reduce potentially deadly medical errors.

The proposed scheduling changes, which could cost as much as $1.7-billion a year, would also ensure a more humane and effective learning environment for doctors in training, said a report from the institute, which is part of the National Academies.

The report, “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety,” also calls for stricter enforcement of the 80-hour-a-week cap on working hours that the Accreditation Council for Graduate Medical Education approved in 2003. Violations are “common and underreported,” it said.

The report recommended overlapping residents’ schedules, so that fewer mistakes happen during shift handoffs. Residents should also be more closely supervised by physicians, and residency-review committees should set guidelines to limit residents’ caseloads, the report said.

“Fatigue, spotty supervision, and excessive workloads all create conditions that can put patients’ safety at risk and undermine residents’ ability to learn,” said Michael M.E. Johns, chancellor of Emory University and chairman of the committee that produced the report.

Residents are now permitted to work 30-hour shifts. Under the proposed changes, a shift of that length would have to be broken by an uninterrupted five-hour nap.

It is unclear how hospitals would cover the additional cost of filling shifts vacated by sleeping or resting residents. If well-rested residents made fewer medical errors, however, the resulting savings would offset some of the cost.

Groups representing neurosurgeons warned that the restrictions could expose residents to fewer complex surgical cases and, as a result, ultimately harm patients.

A national union that represents 13,000 residents welcomed the proposed limit on shifts to 16 hours, but objected to allowing 30-hour stretches that include an enforced nap. “It is difficult to mandate sleep. Our work can be too demanding to free up the time to nap, and it is hard to enforce in practice,” said L. Toni Lewis, president of the union, the Committee of Interns and Residents.

http://chronicle.com Section: Money & Management Volume 55, Issue 16, Page A13