Resident duty hour changes

[runningallthetime]

http://www.emresident.org/resident-duty-hours/

Link to article is above

So now that one of the major studies is done, How do you guys see the EM and resident duty hour restriction changes coming specifically for EM and residents in the coming year?

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[TooMuchResearch]

I don't.

Quotes from the link mixed with my comments:

More than 150 CORD-affiliated EM program directors and educational leaders responded to the survey. The general sentiment from those surveyed is that the current duty hour restrictions are good for resident work-life balance, but may be negatively impacting resident education. Respondents perceived that the current restrictions lead to residents being more concerned about completing their shifts on time than following through on patient care and being invested in patients.

Why do the respondents believe this has anything to do with work hour rules?


RDH standards lead to more patient hand-offs (particularly the 16-hour rule for interns), thus raising concerns for more medical errors and less continuity of patient care.

Does it raise concerns? The patient oriented outcomes evaluated in their quoted study were the same in the two groups.

More handoffs among EM residents and admitting residents leads to longer time to staffing and decisions being made (and thus, longer ED wait times), increased time to admission/discharge, and extended ED boarding times.

My shift length has nothing to do with my ability to staff or admit patients.

Respondents also identified a concern about consultant competency, as these residents now have less overall patient exposure by the time they graduate.

Has anyone shown that graduating residents are less competent?

 

[gutonc]

NB...I'm not in EM.

I can't see this impacting you guys at all. EM already has more restrictive duty hours than any other specialty so it won't change things for you specifically.

And as @TooMuchResearch has pointed out, like most clinical trials, many of the endpoints in both FIRST and iCompare are easily measured and largely clinically irrelevant.

 

[wonderbread12]

Paradoxically, resident surveys show that duty hour restrictions have failed to reduce resident burnout and fatigue

N =1 but practically every resident I know openly states how they don't bother to actually record their duty hours accurately. Many have said they just look at their calendar and put in the exact scheduled hours.

 

[gutonc]

Paradoxically, resident surveys show that duty hour restrictions have failed to reduce resident burnout and fatigue

N =1 but practically every resident I know openly states how they don't bother to actually record their duty hours accurately. Many have said they just look at their calendar and put in the exact scheduled hours.

That's actually N=N. But not relevant to the discussion. Duty hours have in fact decreased. But people record their exact scheduled hours because most of the reporting systems in place pre-populate them and it's just easier to click "OK" to log a whole week than it is to adjust them appropriately on a daily basis.

I mean, if the only thing that can come of accurately recording your work hours is to get your ass handed to you for over (or under...LOL) working, why bother?

 

[wonderbread12]

I mean, if the only thing that can come of accurately recording your work hours is to get your ass handed to you for over (or under...LOL) working, why bother?

well i'd argue that this is the problem and instead of doing all these large studies just address this issue ...but what do i know, I'm sure I'll be clicking "ok" and moving on in a few months just like the rest of us lol

 

[Siggy]

That's actually N=N. But not relevant to the discussion. Duty hours have in fact decreased. But people record their exact scheduled hours because most of the reporting systems in place pre-populate them and it's just easier to click "OK" to log a whole week than it is to adjust them appropriately on a daily basis.

I mean, if the only thing that can come of accurately recording your work hours is to get your ass handed to you for over (or under...LOL) working, why bother?

1. It looks bad when it looks like everyone but one resident is able to work within the hour limits, even if the reality is that everyone else is lying.

2. It's easier to lie about the hours worked than have my ass handed to me.

3. Working a few hours over the limit or having a few hours less time off than the minimum number is less painful than rocking the boat.

4. Sometimes lying helps with fitting personal schedules in. If I trade days off for a specific day off, I might not get 1 day off in a stretch of 7 days, and I might not have 48 contiguous hours off in 14, but I'm still ending up with the same number of days off.

5. Before someone says, "But attendings work more hours or more contiguous hours than residents," that's true, however there's a big difference between working 80 hours a week for $250k/year and working 80 hours a week making less than California's new minimum wage ($15/hour).

 

[filhodeinferno]

well i'd argue that this is the problem and instead of doing all these large studies just address this issue ...but what do i know, I'm sure I'll be clicking "ok" and moving on in a few months just like the rest of us lol

People did that in my program for years. At the start of this year, they emphasized honest recording of duty hours. We saw an un-precedented spike in violations. It was a big concern for the admins. They got us dictation to help charting, even getting scribes as well because most of our violations were from staying late charting. So, in a nutshell, the honest logging of duty hour violations did illicit a response.

Funny, though, that as the academic year went on, less and less people are logging their hours honestly anymore....but we've also seen a huge drop in violations. Hard to say if that's from the interventions to improve workflow or just lack of logging again.

 

[BoardingDoc]

People did that in my program for years. At the start of this year, they emphasized honest recording of duty hours. We saw an un-precedented spike in violations. It was a big concern for the admins. They got us dictation to help charting, even getting scribes as well because most of our violations were from staying late charting. So, in a nutshell, the honest logging of duty hour violations did illicit a response.

Funny, though, that as the academic year went on, less and less people are logging their hours honestly anymore....but we've also seen a huge drop in violations. Hard to say if that's from the interventions to improve workflow or just lack of logging again.

You count charting time?

 

[filhodeinferno]

You count charting time?

Absolutely. It's work related to the shift.

 

[Apollyon]

So, in a nutshell, the honest logging of duty hour violations did illicit a response.

Did you mean "elicit"?

No thread on SDN is complete without either 1. someone MFing EM or 2. grammar Nazi coming in. For the lols, search for "agnosium".

 

[Siggy]

2. grammar Nazi coming in. For the lols, search for "agnosium".

 

[filhodeinferno]

Did you mean "elicit"?

No thread on SDN is complete without either 1. someone MFing EM or 2. grammar Nazi coming in. For the lols, search for "agnosium".

Dammit. I'll blame in on the fact that I was in an MICU post-call delirium . I don't think there was anything illicit about the response it elicited.

 

[hundreddaysoff]

Absolutely. It's work related to the shift.

As is time spent studying, no?

 

[hoot504]

As is time spent studying, no?

Charting is specific to a particular shift. Studying is not. Personally I don't count charting, if I did I would probably be over hours here and there, but strictly speaking, it probably should be counted.

 

[filhodeinferno]

As is time spent studying, no?

Yeah studying....no. Plus, who even has time to study?

 

[TooMuchResearch]

I'd have to pay attention to hours every day to accurately include post shift charting. No thank you.