Training program directors and patient advocates have voiced concerns for years that residents who toil for long shifts on-the-job could harm patients because fatigue increases the risk they will make errors of one sort or another.
A 6 year-old study by the Accreditation Council for Graduate Medical Education gave credence to their concerns by showing that the fatigued residents caused more than half of all preventable adverse events.
In response, the ACGME recently proposed strict new guidelines which would, if adopted, curtail the duration of residents’ shifts and increase supervision requirements for those in charge of their care. The plan extends previous initiatives by the ACGME to limit the work hours of residents.
The new guidelines were published in the New England Journal of Medicine and are subject to a 45-day public comment period.
The fundamental components of the ACGME’s proposal are 16-hour shift limits for first-year residents and 24-hour limits for those in later years of training. Current rules permit residents to work for as many as 30 consecutive hours.
Also included are instructions about the supervision of interns by residents, and beefed-up monitoring and enforcement of the guidelines including annual site visits of each program.
In a replay of what happened the last time ACGME addressed the subject, some physicians and patient advocacy groups said the new guidelines didn’t go far enough. These groups pointed out that the guidelines weren’t as far-reaching as the changes recommended by the Institute of Medicine in 2008.
Meanwhile, some physicians argued the new limitations would impede the educational process and result in more errors…the kind that occur during hand-offs in care at the ends of shifts. Hopefully, some well designed studies of the matter can add value to the debate once (and if) the new guidelines go into effect.