Last month, the Accreditation Council for Graduate Medical Education (ACGME) released new guidelines for restricting the hours worked by resident physicians, but these rules fail to meet benchmarks suggested by the Institute of Medicine (IOM), after a detailed study of the role of resident fatigue in medical errors. However, these rules have also received criticism from some who claim the restrictions simply do not allow enough time for resident physicians to adequately learn what they need to know to enter full practice.
The revision of work hours is the first one since 2003. In 2003, the ACGME mandated that resident physicians should work no more than 80 hours per week when averaged over any four week period, and never more than 30 hours in one shift. The 30-hour shift has been a tradition in American medicine since the late nineteenth century, when cocaine was a readily available pick-me-up, just what the doctor ordered to get him through the night.
However, there is significant evidence that this sleep deprivation leads to doctor errors. In a Harvard study, one in five admitted to making a fatigue-related mistake that hurt a patient, and one in 20 admitted to making a fatigue-related mistake that killed a patient. The actual numbers are likely much higher. Studies have shown that doctors’ performance degrades to the 7th percentile of rested performance. These studies have been joined by a study published in the June issue of the Journal of General Internal Medicine, which showed a 10% increase in fatal medication errors every July when new residents enter teaching hospitals. Studies have shown that the minimally-reduced work hours implemented in 2003 did not significantly reduce patient deaths. As a result, pressure has been on the ACGME to further reduce resident physician working hours.
Now, for the first time, the ACGME is recommending that the 30-hour workday be done away with in favor of 16-hour workdays . . . for first-year residents. All other residents are also limited to a 24-hour shift. However, these limits fall short of the IOM’s recommendations that all residents work no more than 16 continuous hours, and be given on-duty naps with no pagers or interruptions that count toward the 80-hour-per-week limit. The ACGME recommendation encourages naps on 24-hour shifts, but provides no protection for the napping period. The ACGME recommendation also mandates closer supervision of first-year residents, one of the IOM’s recommendations.
The US is virtually the only country where this type of shift is required. In New Zealand, all trainee physicians have been limited to 16 hour shifts since 1985, and in the European Union, work shifts are limited to 13 hours. This practice seems sane and, judging by the relative standard of care in these countries, effective. But if teaching doctors claim there is not enough time to teach doctors all they need to know in a residency of 16-hour shifts, then the residency period should be extended to allow for more training. Unless, of course, the goal is to teach doctors what it feels like to kill a patient.
If you or a loved one has been hurt by a medication error due to doctor fatigue, the medical malpractice lawyers of Robert W. Kerpsack CO, LPA can help. Please call or email us today for a free initial consultation.