have shorter shifts for medical residents had unintended consequences

Back in 2003, the Accreditation Council for Graduate Medical Education — the governing body “responsible for the Accreditation of post-MD medical training programs within the United States” — launched an effort to shorten the number of hours worked by medical residents. The rationale for the move was that it would not only improve the mental and physical welfare of young physicians, but also improve overall patient safety because physicians would be better rested and more alert.

The effort of the ACGME ultimately proved successful as the maximum number of hours that medical residents are able to work per shift was effectively shortened from 30 hours to 16 hours in 2011.

Interestingly, two separate studies published in the Journal of the American Medical Association earlier this week are now calling this move to shorten hours for medical residents a failure and indicating that further evaluation must be undertaken.

One of the studies, undertaken by researchers at the University of Michigan Medical School, sent out surveys to medical students entering residency programs in 2009, 2010 and 2011 across the country. They inquired about the students’ mental health, sleep schedule, work hours, medical errors and other relevant factors.

After analyzing the data, the researchers determined that the medical residents working the new shorter hours weren’t getting more sleep and their rates of depression hadn’t shown marked improvement. Most surprising of all, they found that medical mistakes that harmed patients spiked by 15 to 20 percent when compared with residents who worked longer shifts.

The two studies offer a variety of theories as to why the rates of medical errors have jumped among residents working shorter hours:

  • Hospitals haven’t spent money to help cover clinical work, meaning residents must do more in fewer hours.
  • Shorter shifts translate into more patient handoffs, meaning patients change hands far more often, which serves to increase the possibility of medical errors.
  • Residents forced to perform the same amount of work in a limited number of hours may actually be under increased stress and unable to sleep.
  • Fewer hours in the hospital means less training time.

It’s truly shocking to learn that this policy backfired to such a considerable degree. Here’s hoping that both ACGME and teaching hospitals across the U.S. recognize the problem and take the necessary steps to rectify it.

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Source: USA Today, “Studies: Residents make more errors on shorter shifts,” Janice Lloyd, March 25, 2013

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