Boston’s BI-Deaconess’ surgery program was cited for violations of the strict resident work hour restrictions. No doubt, this is happening in hospitals across the country:
“When your 80 hours are up on Friday and someone comes in with a ruptured aneurysm, we don’t have the luxury of saying ‘Sorry, I have to go home,'” said Dr. Scott Johnson, a transplant surgeon who has headed the hospital’s surgery training …
| If I Knew Then – Dr. Meeta Prasad, MD, University of Pennsylvania School of Medicine, on Work Hours Reform |
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How resident work-hour restrictions is affecting housestaff:
The conversation is shifting. Traditional hierarchical patient management is giving way to the need for “scut management” as work hours, thrown in amongst teaching sessions, draw short. Divide-and-conquer. No time for supervision. Hurry up! We’ve got to get done!
These restrictions have to be accompanied by a sizable bump in ancillary staff to reduce scut. Filling out paperwork and drawing …
Frequent NY Times contributer Sandeep Jauhar has a piece in Slate talking about night float, where interns take a 12 to 14 hour shift overnight to cross-cover the entire hospital.
Sometimes the problem of caring for another doctor’s patients can lead to medical errors:
The nightmare of night float raises a central question about work limits for interns: Is it better to be cared for by a tired resident …
Restrictions on work hours don’t exist when you’re an attending. Will today’s residents be ready?
So you’re a general surgery intern. You’ll be working 80 hour weeks (and possibly less than 60 hrs if further reforms are implemented). Post call, you’ll be eating breakfast and reading the newspaper in the comforts of your own home by 8am, irrespective of any work that remains to be done on the …
Rumor has it that resident work hours will be shortened to 56-hours per week. How to make up the experience? Add a year to residency of course.
I wonder how many medical students would support that, considering the burden of $140,000 they have in school loans waiting to be repaid.
Robert Centor with further thoughts.
Studies in JAMA suggest no improvement in mortality:
Cutting the grueling work hours of doctors-in-training had little effect on reducing patient deaths, according to two large studies . . .
. . . For the groups with no change, Volpp said one possible explanation is that more patient handoffs by residents offset the benefits of reduced fatigue.
Update:
Roy Poses with his thoughts.
Zagreus Ammon with a somewhat different take:
I don’t think working forty eight hours straight is the problem. More likely the fact that those 48 hours have become as grueling and punishing as an ultra-marathon. The fact is that medical interventions have become much more intense than ever before and no patient lounges around the hospital waiting to get better. The cost-containment pressures on the health care system have …
Limiting resident work hours may be linked with an increase in surgical complications:
Using data from the trauma center at the Los Angeles County + University of Southern California Medical Center, researchers compared outcomes before and after the limits were introduced. They found that the death rate didn’t change significantly. But the rate of “preventable complications” rose after the work limits were introduced. “This increase in complication rate may …
Who do you believe?
Some residents may not be adhering to the rules. While a study by the group that accredits residency programs found that only 3% of residents worked more hours than the rules allowed, Harvard sleep researchers found that 80% of residents they surveyed worked excess hours.
Maria comments on the recent debate about the pros and cons of limiting residents’ work hours. The key is limiting the perils of the hand-off/sign-out to covering physician. Some don’t seem to realize the potential dangers of this.
retired doc on the effects of limiting residents’ work hours:
Do we not learn in part by making errors in an environment where we are buffered and protected by our mentors and more senior colleagues? How will this cohort of residents fare when they are truly out on their own and there will be no team to hand off to when they have been up most of the night …
Attendings pick up the patient care slack when house staff goes home, resulting in less teaching.
A case where a patient died due to multiple handoffs. retired doc criticizes the trend:
We seem to be replacing personal physician responsibility with “systems”.
What lessons are being implicitly taught to the house staff? The procedure doc seems to have no post procedure responsibility but is content to delegate care to a NP. In that environment how surprised could you be to learn the intern …
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