The Institute of Medicine recently recommended a requirement that medical and surgical residents have a minimum sleep period of 5 hours in any 24-hour work period, with a maximum shift length of 16 hours. This was a follow-up to the 2003 ruling which limited resident work-hours to 80 hours per week.
That is the focus of this week’s poll. Are the Institute of Medicine’s recommended restrictions on residents’ work hours good for medicine?
Here are the issues as I see them.
There is no doubt that fatigue impairs judgment. Residents who stay awake for more than 24 hours are impaired to a point similar to those who are legally drunk. A study compared one group of residents who slept 7 1/2 hours a day to another who slept just under one hour less. The group that received less sleep made 36 percent more serious medical errors. It seems intuitive that giving residents more rest would decrease mistakes and improve patient outcomes.
That however, isn’t always the case. Since work-hours were restricted in 2003, there are no studies that have shown any marked improvements in patient safety or outcomes. Worse, errors have arisen from the so-called “patient hand-off,” the period of communication where rested doctors replace those who are fatigued. Does increasing the frequency of patient hand-offs outweigh the benefit of better rested doctors?
Limiting resident work also increases costs, as hospitals are forced to hire more hospitalists, mid-level providers, and ancillary staff to make up for lost resident work time. For instance, implementing the new Institute of Medicine recommendations is estimated to cost an additional $1.7 billion. Are financially-strapped hospitals ready to make that commitment?
Finally, the impact on training itself has to be considered. Surgery residents are forced to do fewer cases, giving them less experience to operate in the real world. Instead of caring healers who sacrifice and dedicate themselves to patients, we are in danger training a generation of shift-work providers who punch out on the clock.
If I didn’t cover your issue, you can add it in the comments, or call into the ReachMD Listener Line at 888-639-6157 and record your comments (portions of which may air).
I encourage you to listen and vote in this week’s poll, located in the upper right column of the blog.
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