More Rest for the Weary

Medical and surgical residents aren’t stocking up on flannel pajamas just yet, but if an expert panel commissioned by the Institute of Medicine has its way, they will be working no more than 16 consecutive hours before qualifying for 5 hours of rack time.

In commenting on the shift-length reductions for the Washington Post, panel chief Michael M. E. Johns said “our overarching conclusion is that the science clearly shows that fatigue increases the chances of (medical) errors.”

Excessive fatigue has direct negative effects on residents as well, increasing the risk of depression and auto accidents for example.

In 2003 the Accreditation Council for Graduate Medical Education announced it would allow shifts of up to 30 consecutive hours while setting at 80 hours an upper limit on the work week.

The IOM panel did not suggest reducing the 80 hour work week because the replacement manpower simply isn’t there and if it were, putting all those new people to work would cost billions.

Meanwhile, flaunting ACGME rules has become an art form. That first year after the rules went into effect for example, 43% of interns claimed they worked more than 80 hours per week on a regular basis.

A more recent study from Vanderbilt found that 85% of residents had violated the 30-hour shift maximum during in the last year.

The expert panel acknowledged that shift limit manipulations have complex effects on the quality of care. In particular, reductions in errors caused by fatigue might be offset by increases in errors that transpire during patient “handoffs” at the change of shift.

And the news wasn’t all good for residents. The panel also wants to reduce allowable moonlighting hours meaning some won’t pay off their school loans until they’re old enough to qualify for social security.

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