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Reforms recommended to prevent medical errors from resident fatigue
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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.”
As reported on OrthoSuperSite.com, 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.
The recommendations are the product of a Harvard Medical School conference which was held last June to create a plan for implementing residency reform recommendations the Institute of Medicine published in 2009.
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The recommendations address important shortcomings in medical training. Patients currently bear the burden and potential for adverse consequences from the way medical care is designed, yet are largely unaware of the risks to which they are exposed. As a medical community, we have a fiduciary responsibility to create a safer medical system. Changing the way in which care is delivered is challenging, and will have financial and other consequences which can hopefully be off-set by decreased rates of medical errors. Changes should occur in a rational and measured manner to ensure that unintended consequences are minimized, and medical training and overall care are improved.
— Michael Nurok, MD, PhD
Clinical
Associate Professor
Weill Cornell Medical College
Department of
Anesthesiology
Hospital for Special Surgery New York City
Disclosure: He has no relevant financial disclosures.