interesting article... says that residents driving after work are as dangerous on the road as drunk drivers
http://articles.health.msn.com/id/100099965/site/100000000/?GT1=5943
http://articles.health.msn.com/id/100099965/site/100000000/?GT1=5943
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Med students = drunk drivers
Started by pakidoc
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Blake said:
it's not just med students; it's anyone who doesn't get enough sleep. I hate to admit how often my eyes close at the wheel especially after pulling all-nighters, but sometimes in general b/c I never get enough sleep. I'm fine in the morning but by afternoon/evening i'm a zombie.
Clearly driving while being tired is dangerous. Wouldn't treating patients while being sleepy also be hazardous for the sick? I'd imagine that if a person that has trouble driving home would also have issues at the end of their shift. Or is it that residents can finally relax after work in their cars on the way home, causing them to fall asleep?
i think that's exactly it. I know i can keep going until i'm given a chance to relax and then it's all over. Forget movies, tv, anything with the lights off; i'd be out in a second..i make a terrible date. 🙁RaistlinMajere said:
"Young doctors-in-training who work the long shifts required by most hospitals are so woozy when they drive home, they run the same risk of a car accident as someone who is legally drunk, a new Harvard study finds."
What is legally drunk, does that mean you are ok to drive? I wonder why the compharision was made to a group who is legally alowed to drive.
Cause
What is legally drunk, does that mean you are ok to drive? I wonder why the compharision was made to a group who is legally alowed to drive.
Cause
cause2003 said:
I'm not sure if you're being sarcastic or not, but legally drunk means "drunk according to the state laws," as in above a .08 or .10 BAC (depending on the state).
I hope that by the time we're in our residencies, the medical profession will have come up with some new ways to teach us a difficult without driving us into the ground. I believe that a lot of it is just inertia, that's the way they did it in the old days, so that's the way we have to do it. Do we really have to work 36 hours in a row to be good at our jobs? It's an anachronism that I would like to see go the route of snake oil and leeches. If not, I'm buying stock in No-Doz now...
Hopefully, there is enough momentum to produce change.
Here is a snip from the abstract of an accompaning article.
http://content.nejm.org/cgi/content/abstract/352/2/125?view=abstractpmid=15647575
Results The odds ratios for reporting a motor vehicle crash and for reporting a near-miss incident after an extended work shift, as compared with a shift that was not of extended duration, were 2.3 (95 percent confidence interval, 1.6 to 3.3) and 5.9 (95 percent confidence interval, 5.4 to 6.3), respectively. In a prospective analysis, every extended work shift that was scheduled in a month increased the monthly risk of a motor vehicle crash by 9.1 percent (95 percent confidence interval, 3.4 to 14.7 percent) and increased the monthly risk of a crash during the commute from work by 16.2 percent (95 percent confidence interval, 7.8 to 24.7 percent). In months in which interns worked five or more extended shifts, the risk that they would fall asleep while driving or while stopped in traffic was significantly increased (odds ratios, 2.39 [95 percent confidence interval, 2.31 to 2.46] and 3.69 [95 percent confidence interval, 3.60 to 3.77], respectively).
Conclusions Extended-duration work shifts, which are currently sanctioned by the Accreditation Council for Graduate Medical Education, pose safety hazards for interns. These results have implications for medical residency programs, which routinely schedule physicians to work more than 24 consecutive hours.
Here is a snip from the abstract of an accompaning article.
http://content.nejm.org/cgi/content/abstract/352/2/125?view=abstractpmid=15647575
Results The odds ratios for reporting a motor vehicle crash and for reporting a near-miss incident after an extended work shift, as compared with a shift that was not of extended duration, were 2.3 (95 percent confidence interval, 1.6 to 3.3) and 5.9 (95 percent confidence interval, 5.4 to 6.3), respectively. In a prospective analysis, every extended work shift that was scheduled in a month increased the monthly risk of a motor vehicle crash by 9.1 percent (95 percent confidence interval, 3.4 to 14.7 percent) and increased the monthly risk of a crash during the commute from work by 16.2 percent (95 percent confidence interval, 7.8 to 24.7 percent). In months in which interns worked five or more extended shifts, the risk that they would fall asleep while driving or while stopped in traffic was significantly increased (odds ratios, 2.39 [95 percent confidence interval, 2.31 to 2.46] and 3.69 [95 percent confidence interval, 3.60 to 3.77], respectively).
Conclusions Extended-duration work shifts, which are currently sanctioned by the Accreditation Council for Graduate Medical Education, pose safety hazards for interns. These results have implications for medical residency programs, which routinely schedule physicians to work more than 24 consecutive hours.
Part of the resident hours debate has been whether there would actually be a reduction in medical errors if hours were reduced.
While it seems obvious that extended sleep deprivation would cause errors especially if sleep deprived to levels that reduce functioning to a level equivalent to drunk driving. Obvious or not-there have not been any research to show a connection. (as an outsider, I have wondered why the research was not done? No interest? No low hour programs to study?)
Recent studies of errors since the 80 hour week went into effect have showin INCREASED errors! Thas mostly been shown to been correlated with poor handoffs of patients (fewer hours means the same resident isn't covering the same patient as long = more handoffs.) In other words, poor systems, and growing pains. Nevertheless, it has aided the arguments of those arguing against the 80hour regs.
Finally, there has been a study showing increased errors do occur with long hours. Hopefully, many more studies will follow to examine this issue.
The article was in the oct 28. 2004 NEJM
Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units
pubmed abstract:
Although sleep deprivation has been shown to impair neurobehavioral performance, few studies have measured its effects on medical errors. METHODS: We conducted a prospective, randomized study comparing the rates of serious medical errors made by interns while they were working according to a traditional schedule with extended (24 hours or more) work shifts every other shift (an "every third night" call schedule) and while they were working according to an intervention schedule that eliminated extended work shifts and reduced the number of hours worked per week. Incidents were identified by means of a multidisciplinary, four-pronged approach that included direct, continuous observation. Two physicians who were unaware of the interns' schedule assignments independently rated each incident. RESULTS: During a total of 2203 patient-days involving 634 admissions, interns made 35.9 percent more serious medical errors during the traditional schedule than during the intervention schedule (136.0 vs. 100.1 per 1000 patient-days, P<0.001), including 56.6 percent more nonintercepted serious errors (P<0.001). The total rate of serious errors on the critical care units was 22.0 percent higher during the traditional schedule than during the intervention schedule (193.2 vs. 158.4 per 1000 patient-days, P<0.001). Interns made 20.8 percent more serious medication errors during the traditional schedule than during the intervention schedule (99.7 vs. 82.5 per 1000 patient-days, P=0.03). Interns also made 5.6 times as many serious diagnostic errors during the traditional schedule as during the intervention schedule (18.6 vs. 3.3 per 1000 patient-days, P<0.001). CONCLUSIONS: Interns made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts. Eliminating extended work shifts and reducing the number of hours interns work per week can reduce serious medical errors in the intensive care unit. Copyright 2004 Massachusetts Medical Society.
While it seems obvious that extended sleep deprivation would cause errors especially if sleep deprived to levels that reduce functioning to a level equivalent to drunk driving. Obvious or not-there have not been any research to show a connection. (as an outsider, I have wondered why the research was not done? No interest? No low hour programs to study?)
Recent studies of errors since the 80 hour week went into effect have showin INCREASED errors! Thas mostly been shown to been correlated with poor handoffs of patients (fewer hours means the same resident isn't covering the same patient as long = more handoffs.) In other words, poor systems, and growing pains. Nevertheless, it has aided the arguments of those arguing against the 80hour regs.
Finally, there has been a study showing increased errors do occur with long hours. Hopefully, many more studies will follow to examine this issue.
The article was in the oct 28. 2004 NEJM
Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units
pubmed abstract:
Although sleep deprivation has been shown to impair neurobehavioral performance, few studies have measured its effects on medical errors. METHODS: We conducted a prospective, randomized study comparing the rates of serious medical errors made by interns while they were working according to a traditional schedule with extended (24 hours or more) work shifts every other shift (an "every third night" call schedule) and while they were working according to an intervention schedule that eliminated extended work shifts and reduced the number of hours worked per week. Incidents were identified by means of a multidisciplinary, four-pronged approach that included direct, continuous observation. Two physicians who were unaware of the interns' schedule assignments independently rated each incident. RESULTS: During a total of 2203 patient-days involving 634 admissions, interns made 35.9 percent more serious medical errors during the traditional schedule than during the intervention schedule (136.0 vs. 100.1 per 1000 patient-days, P<0.001), including 56.6 percent more nonintercepted serious errors (P<0.001). The total rate of serious errors on the critical care units was 22.0 percent higher during the traditional schedule than during the intervention schedule (193.2 vs. 158.4 per 1000 patient-days, P<0.001). Interns made 20.8 percent more serious medication errors during the traditional schedule than during the intervention schedule (99.7 vs. 82.5 per 1000 patient-days, P=0.03). Interns also made 5.6 times as many serious diagnostic errors during the traditional schedule as during the intervention schedule (18.6 vs. 3.3 per 1000 patient-days, P<0.001). CONCLUSIONS: Interns made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts. Eliminating extended work shifts and reducing the number of hours interns work per week can reduce serious medical errors in the intensive care unit. Copyright 2004 Massachusetts Medical Society.
DianaLynne said:
I hope this is true - there seems to be some recognition of a problem, attention in the journals to the issue, hopefully the attention & momentum will lead to some changes. Several articles have studied the ammount of scut / non-educational activities residents do (and I think on the low side they find 20-25% of the time is spent doing this.) Several people have suggested more efficient approaches could reduce hours, errors, and even cost by cutting this work. Hopefully these ideas catch on.
It worries me a little that medical school applications are on the upswing again, I was thinking another few years of low applications might convince people that this was a detering factor and that action needs to be taken. (Although, honestly, I don't think most premeds consider this or the IRR of a business school vs law vs medical degree or any of the other issuses that come up to explain the ups and down of applicaitons!)
Is one of the reasons that residents have to work such incredibly long hours is because they need the staffing? With a limited graduating class each year and limited funding to create residencies, perhaps hospitals have created an understaffing situation and residents turn out to be slave labor.
I've heard that in the near future the nation will have larger med school classes and more funding for residency positions. Perhaps in time we can learn to do more efficient handoffs and errors can be reduced.
I've heard that in the near future the nation will have larger med school classes and more funding for residency positions. Perhaps in time we can learn to do more efficient handoffs and errors can be reduced.
