Last week, the Accreditation Council for Graduate Medical Education announced plans to reduce the maximum consecutive work hours for first-year medical residents to 16, down from 24.
That's a start, say patient advocates, but not enough to reduce medical errors attributed to young doctors, particularly in July when medical school graduates join teaching hospitals.
"If you have young people who are just starting out ... and they're totally exhausted to boot, that's dangerous for everyone," said Helen Haskell, who founded Mothers Against Medical Error after her 15-year-old son bled to death in a South Carolina hospital in 2000 following an elective surgery.
Haskell supports 12-hour maximum shifts for all doctors.
"If you're working 16 hours a day, you're obviously not getting eight hours of sleep," she said. "It shouldn't be this hard to introduce sanity to the practice of medicine."
In a 2008 report to Congress, the Institute of Medicine recommended maximum 16-hour shifts for all medical residents. Residencies are the three to seven years of specialty training and research that doctors practice after graduating from medical school.
With more than 100,000 residents working in the United States, the institute estimated it would cost $1.7 billion a year to cover the staffing if residents' shifts were limited to 16 hours.
The graduate education council, which sets the rules on residents' work conditions, proposed changes for first-year residents, often called interns. Under the new rules, interns would be more closely supervised and could only work a maximum of 16 consecutive hours.
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Maximum shifts would stay at 24 consecutive hours (up to 30 in certain situations) and a limit of 80 total work hours in a week for all other residents.
Research on sleep deprivation has shown that medical errors increase along with the length of a doctor's shift. A doctor who has worked a 24-hour shift without sleep is as impaired as if he had a blood-alcohol level of 0.10, said Dr. Charles Czeisler, professor of sleep medicine at Harvard School of Medicine.
"It is hazardous to be awake for 24 consecutive hours," said Czeisler, who called the rule changes "insufficient."
On some rotations in their training, residents at Barnes-Jewish Hospital in the Central West End can work up to two 24-hour shifts a week.
A benefit of long shifts is the opportunity to teach new doctors to work under stress and adverse conditions they will encounter in practice, said Dr. Melvin Blanchard, director of the hospital's internal medicine residency program.
A recent study acknowledged the so-called "July effect," known in health care as the month when new doctors start and errors increase. Medication errors in hospitals spike 10 percent in July, according to the University of California, San Diego.
Researchers combed 62 million U.S. death certificates from 1979 to 2006 and found about 250,000 that were attributed to medication errors in hospitals.
The number of medication errors corresponded to the number of teaching hospitals in an area, the study found. The study's authors attribute the jump in errors in part to apprentice doctors just starting their medical careers.
Medical errors are too complex to lay blame on long shifts or new doctors, Blanchard said.
"There are many, many people in the hospital besides physicians," he said. "Having said that, I think that it's important that we pay attention to the effect of fatigue on physicians' decision-making."
As many as 1,000 physicians-in-training work at Barnes-Jewish Hospital, the largest teaching hospital in the state. New computer programs there can virtually eliminate medication errors, according to a statement from Dr. John Lynch, chief medical officer.
"When first-year residents ... begin their residencies in July, we are confident that the systems of care we have put into place allow for the highest levels of patient safety and quality."
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Patient Advocates Wary of New RulesOriginally from: http://www.nursinglink.monster.com/news/articles/14654-patient-advocates-wary-of-new-rules
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