Overworked Residents

[PublicHealth]

---

Members don't see this ad.

http://www.news.harvard.edu/gazette/daily/2004/10/27-errors.html

 

[Annette]

Nice! Now maybe the traditionalists will stop saying that there is no research to support more sleep for the residents is better for the patients! Heaven knows that that surge of adrenaline of knowing a patient's life is at stake is going to overcome biology. Or maybe the powers that be don't really care that we aren't sympathetic to a patient's family member whining that they have to be up in 3 hours to go to work when we are trying to get their mother admitted. I'm rambling. I need some sleep.

 

[osuer]

I hate to say, "I told you so," but, well, what else can you say? Finally--evidence to support what has been common sense for so many years!

 

[MadameLULU]

There was a segment about this on NPR yesterday. They mentioned that Harvard will be reducing intern's shift hours starting next year. I'm sure other schools will follow this trend.

 

[Winged Scapula]

In the case of medication errors, one has to wonder whether sleep deprivation really is the cause. That is, while the sleep deprived intern/resident may write an incorrect order, the nurse taking the order off, the pharmacist dispensing the incorrect dose and the nurse administering the incorrect dose didn't seem to catch the error and ask for clarification or correction. Presumably these allied health care professionals aren't sleep deprived - so why are they catching the mistakes?

This obviously doesn't excuse long hours, or the intern/resident from writing an incorrect order, but there are supposed to be steps in the system to prevent these kind of mistakes.

 

[GeneGoddess]

I'm actually a part of another one of Dr. Czeisler's studies and have been for a few years. It's a monthly email questionaire asking about sleep and work habits, plus medications and such. They classify the people into different categories (I'm not in the "intern" section, obviously). I'll be interested in seeing the results of that study, since the sample group is MUCH larger.

 

[AJM]

In the case of medication errors, one has to wonder whether sleep deprivation really is the cause. That is, while the sleep deprived intern/resident may write an incorrect order, the nurse taking the order off, the pharmacist dispensing the incorrect dose and the nurse administering the incorrect dose didn't seem to catch the error and ask for clarification or correction. Presumably these allied health care professionals aren't sleep deprived - so why are they catching the mistakes?

This obviously doesn't excuse long hours, or the intern/resident from writing an incorrect order, but there are supposed to be steps in the system to prevent these kind of mistakes.

Actually, in most of the errors in the study, the mistakes were caught. They were counting only errors that originated from the interns in the study, regardless of whether they were carried through to affect the patient. For example, if an intern ordered a wrong medication dose, but it was caught by pharmacy or a nurse, it still counted as an error.

The interesting thing to note is that while there were more medical errors made in the group with the longer shifts, there was no patient mortality difference, and no difference in length of hospital stay. This seems to be a finding of the study that many people want to ignore. One could make an argument that there was no mortality difference because of the checks and balances system, however there are probably many hospitals out there that don't have a very good system to double check doctor's actions...

 

[AJM]

There was a segment about this on NPR yesterday. They mentioned that Harvard will be reducing intern's shift hours starting next year. I'm sure other schools will follow this trend.

And BWH, which is where the study was conducted, is working on changing the MICU schedules within the next couple of months (rather than waiting nearly a year) because of the results of the study. It will be interesting to see what system they come up with.

 

[Eidolon6]

Actually, in most of the errors in the study, the mistakes were caught. They were counting only errors that originated from the interns in the study, regardless of whether they were carried through to affect the patient. For example, if an intern ordered a wrong medication dose, but it was caught by pharmacy or a nurse, it still counted as an error.

The interesting thing to note is that while there were more medical errors made in the group with the longer shifts, there was no patient mortality difference, and no difference in length of hospital stay. This seems to be a finding of the study that many people want to ignore. One could make an argument that there was no mortality difference because of the checks and balances system, however there are probably many hospitals out there that don't have a very good system to double check doctor's actions...

Good pharmacists and nurses are life-savers when it comes to thwarting medication errors and are often the unsung heros when it comes to optimizing patient care, esp. in training settings.....think about thanking the pharmacist every once in a while for catching medication errors....

 

[Fro]

its in NEJM this week
this could end up being a big issue if lawyers latch onto it

 

[axm397]

The news made it to MSNBC - http://www.msnbc.msn.com/id/6346069/

How are they going to implement 16hr shifts? I guess night float would be the only way to go... (And with the 80hr work week, you can only work 5 shifts! - hmmmm.... )

It's like we're all going to do a Emergency Medicine residency... shift work, not much continuity - but I guess better lifestyle!

 

[docB]

The news made it to MSNBC - http://www.msnbc.msn.com/id/6346069/

How are they going to implement 16hr shifts? I guess night float would be the only way to go... (And with the 80hr work week, you can only work 5 shifts! - hmmmm.... )

It's like we're all going to do a Emergency Medicine residency... shift work, not much continuity - but I guess better lifestyle!

An excellent point. In ER we have a very high liability risk with cases that are handed off at shift change. If everyone switches to night floats ect. that liability will likely be similar. So the question is which causes more mistakes. Tired people docs who don't know the pts.

 

[southerndoc]

An excellent point. In ER we have a very high liability risk with cases that are handed off at shift change. If everyone switches to night floats ect. that liability will likely be similar. So the question is which causes more mistakes. Tired people docs who don't know the pts.

Actually ICU mistakes would be less than ED mistakes if a shift system was implemented. A patient typically has his/her diagnosis and treatment plan in place in the unit, whereas many patients that are signed out during ED shift change do not have a diagnosis, firm disposition, nor a firm treatment plan.

 

[osuer]

Why are we discussing whether shorter shifts and increased handoffs will lead to increased medical errors? This is exactly what the study addressed, and found that longer shifts--with their increased continuity--lead to a significant increase in the rate of medical errors. In the Wall Street Journal article, one of the authors states this is what they intended to determine--whether increased handoffs are of greater detriment than the effects of fatigue--and found that this was not the case.

 

[roja]

I think the point that is being made is that if you are aware of where medical mistakes are more commonly made (as the group my have been) then you can avoid making those mistakes.

In the ED, we are aware that in our 12 hour shifts, that there are more mistakes made with signing over a patient. That awareness makes us more vigilent and thus helps to reduce those errors.

Even if its just 'this patient doesn't look good to me, keep an eye on them'.