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Report finds doctors-in-training need their zzz's after working 16-hour shifts; Locally, Summa caps hours to cut back on errors from sleep deprivation
By Cheryl Powell
Beacon Journal medical writer
Published on Wednesday, Dec 03, 2008
This might be just what many doctors-in-training at hospitals here and nationwide ordered: More sleep.
A report issued Tuesday by the Institute of Medicine recommends that hospitals let their sleep-deprived physician residents take a five-hour nap after working 16 hours.
This and other recommendations to address the problems of overworked residents come five years after the Accreditation Council for Graduate Medical Education limited bleary-eyed residents' shifts to about 80 hours a week, with individual shifts capped at 30 hours.
Before then, residents in some specialties could work as many as 120 hours a week.
But even those limits might not be enough.
The new Institute of Medicine report found ''considerable scientific evidence that 30 hours of continuous time awake, as permitted and common in current resident work schedules, can result in fatigue.''
''The science on sleep and human performance is clear that fatigue makes error more likely to occur,'' the institute stated in its report.
At issue is how to balance patient safety with the education of roughly 100,000 medical residents. These doctors, fresh out of medical school, spend three to seven years in on-the-job training for their specialty.
At least one Akron residency program already is capping hospital shifts at 16 hours.
About two years ago, Summa Health System decided to limit shifts for residents in its internal medicine program to 16 hours as part of a pilot program.
''There were articles that came out, good research that found tired residents did make more errors than other residents,'' said Dr. David Sweet, director of Summa's internal medicine residency program.
Residents still get the same training
and see the same number of patients, he said, but they work shorter shifts that have been adjusted to promote ''working smarter.''
Some residents, for example, now start work in the late afternoon, when many patients are admitted, rather than all starting early in the day, he said.
''Our residents get the same volume of patient experience as they did before, but they're not here as long,'' Sweet said. ''They're not rushed. They're not tired because they've been up for 24 to 30 hours at a time.''
The Accreditation Council for Graduate Medical Education is studying the effectiveness of Summa's initiative, which was selected as one of 17 Educational Innovation Projects, Sweet said.
Ron Conner, a second-year internal medicine resident at Summa, said he was pleasantly surprised by the 16-hour shift policy when he started his residency after graduating from the Northeastern Ohio Universities Colleges of Medicine and Pharmacy.
He called the shifts ''more than reasonable'' and said the hours allow him to balance work and life while learning more effectively.
''I worked much longer hours as a medical student than as a resident,'' he said. ''I realize that I can't really digest what I'm learning and process it if I don't have the time to recuperate and rest.''
The long hours are in some ways a badge of the profession; doctors can't simply clock out if a patient is in danger.
But sleep deprivation fogs the brain, a problem that can lead to serious medical mistakes.
Akron Children's Hospital monitors its residents to make sure they don't work more than 80 hours a week, said Dr. Jeffrey Kempf, program director of the pediatric residency program.
''There is data to show that when you're sleep deprived, you do function differently,'' he said.
But doctors-in-training also benefit from staying with the same patients for many hours and seeing how their conditions change, he said.
''It's important for young physicians to see progression of disease,'' he said. ''If you're only there for a short period of time, you might miss that in your education.''
The government asked the Institute of Medicine to study the current caps. Violations of current limits are common but residents seldom complain, the committee found. While quality of life has improved, there's still a lot of burnout.
And despite one study that found residents made more errors while working longer shifts, patient safety depends on so many factors that it's impossible to tell yet whether the caps helped that problem, the report said.
The Institute of Medicine also recommends:
• Experienced physicians should more closely supervise residents.
• Schedules should overlap better to reduce the chances for error as one doctor hands patients over to the next.
• Mandatory days off each month should be increased, and hours off between shifts should be extended, depending on how long the resident worked, during the day or night.
• ''Moonlighting,'' or working additional paid medical jobs, should be restricted.
The accreditation council didn't say whether it would follow the recommendations.
The Associated Press contributed to this report.
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
This might be just what many doctors-in-training at hospitals here and nationwide ordered: More sleep.
Get the full article here.
Comments
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Posted 05:51 AM, 12/03/2008
I would say greed plays the biggest roll in why they want to work so many hours. How is the pay based?
Posted 07:29 AM, 12/03/2008
It's amazing how ignorant people are. Being a resident is not like working at the Ford plant. You don't get overtime. You get a set amount per year. You work as many hours as you are required. If there is any greed involved it's on the part of the hospital. They get medical care for their patients round the clock at the lowest pay rate in the hospital.
Posted 08:40 AM, 12/03/2008
Residents do what they are told and work the hours they are told to work. I am glad to see the hospital thinking of them and their patients. My doctors are residents, thank you for the care you provide.
Posted 08:54 AM, 12/03/2008
I agree with M. If you add it up, residents make about minumum wage with all the hours they work. It's the hospital being greedy and hours have been cut back before in hospitals due to safety concerns. Take a look at the Libby Law http://en.wikipedia.org/wiki/Libby_Zion
Akron, oh
Posted 08:56 AM, 12/03/2008
Years ago a doctor said the reason is simple legacy for these hours. "I had to work these hours and go through hell and so will they."
Posted 09:50 AM, 12/03/2008
Most doctors will tell you that a tremendous amount of learning happens during those long hours. I'm not for 36 hour shifts, as in the past, but the more you experience the more you know to take with you into practice.
Akron, OH
Posted 03:23 PM, 12/03/2008
Most of the residents on the west side sleep until noon each day. Now, that's a residency those aspiring doctors could go for.
