Revised hours and workloads for medical residents needed to prevent
Dec 2, 2008 - 5:00:00 AM
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Fatigue, spotty supervision, and excessive workloads all create conditions that can put patients' safety at risk and undermine residents' ability to learn, said committee chair Michael M.E. Johns, chancellor, Emory University, Atlanta. Health care facilties can create safer conditions within the existing 80-hour limit by providing residents regular opportunities for sleep and limiting extended periods of work without rest. But these steps should be supplemented by additional efforts to improve patient safety and ensure residents get the full experience they need to safely and competently practice medicine at the end of their training.
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By National Academy of Sciences,
[RxPG]
WASHINGTON -- A new report from the Institute of Medicine proposes revisions to medical residents' duty hours and workloads to decrease the chances of fatigue-related medical errors and to enhance the learning environment for these doctors in training. The report does not recommend further reducing residents' work hours from the maximum average of 80 per week set by the Accreditation Council for Graduate Medical Education (ACGME) in 2003, but rather reduces the maximum number of hours that residents can work without time for sleep to 16, increases the number of days residents must have off, and restricts moonlighting during residents' off-hours, among other changes.
Altering residents' work hours alone, however, is not a silver bullet for ensuring patient safety, stressed the committee of medical and scientific experts that wrote the report. The committee also called for greater supervision of residents by experienced physicians, limits on patient caseloads based on residents' levels of experience and specialty, and overlap in schedules during shift changes to reduce the chances for error during the handover of patients from one doctor to another.
Financial costs and an insufficient health care work force are the biggest barriers to further revising resident hours, the report notes. It calls for additional funding for teaching hospitals, estimating that the additional costs associated with shifting some work from current residents to other health care personnel or additional residents could be in the ballpark of $1.7 billion per year.
Fatigue, spotty supervision, and excessive workloads all create conditions that can put patients' safety at risk and undermine residents' ability to learn, said committee chair Michael M.E. Johns, chancellor, Emory University, Atlanta. Health care facilties can create safer conditions within the existing 80-hour limit by providing residents regular opportunities for sleep and limiting extended periods of work without rest. But these steps should be supplemented by additional efforts to improve patient safety and ensure residents get the full experience they need to safely and competently practice medicine at the end of their training.
Studies showing the detrimental effects of fatigue on human performance underlie the committee's recommendations to reduce maximum shift lengths and to increase opportunities for residents to catch up on sleep. Because no single model of scheduling fits all training facilities or medical specialties, the committee offered two options for dealing with extended shifts. Residents either could work a maximum shift of 16 continuous hours or they could work a 30-hour shift provided that they get an uninterrupted five-hour break for sleep after working 16 hours. Sleep breaks during shifts should count toward the 80-hour limit. In addition, the committee recommended:
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