Reforms recommended to prevent medical errors from resident fatigue

Blum AB. Nature Science Sleep. 2011; 3:47-85.

Issue: July 2011

Concerns about residents’ lack of sleep causing serious medical errors led 26 national medical professionals to release recommendations for resident supervision and training.

In a list of recommendations, recently published in Nature & Science of Sleep, professionals in medicine, health care, patient safety, and research suggested that resident physician work hours be reduced to less than 16-hour stretches at a time. According to a press release, the recommendations also called for the Accreditation Council for Graduate Medical Education (ACGME) to make “work-hour compliance a condition of participation for Medicare graduate medical education (GME) support.”

The ACGME agreed to reduce work hours to less than 16 hours for first-year residents starting July 1, 2011. However, the ACGME will continue to allow senior residents to work up to 28 hours nonstop.

Charles Czeisler, PhD, MD, a co-author of the report and chief of the Division of Sleep Medicine at Brigham and Women’s Hospital in Boston, warned the ACGME’s rules encompass “a small fraction” of residents and will not solve the problem.

“Extensive research has shown that experience does not overcome the need for sleep, Czeisler stated in the press release. “There is no justification for maintaining unsafe work hours, other than they’re a good deal for hospitals. But they endanger patients, and they even endanger residents.”

The group also recommended institutions look at how much workload is excessive for residents and reduce the workload for tasks unimportant to their education, such as paperwork and drawing blood. They also called for supervision of hospital admissions and critical care services. Other suggestions included providing transportation to tired residents to ensure that they arrive home safely and establishing moonlighting policies.

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