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From http://www.cnn.com/2005/HEALTH/01/13/sleep.doctors.reut/index.html
PROVIDENCE, Rhode Island (Reuters) -- Overworked, sleepy doctors-in-training who hit the road after work are as much a hazard as drunk drivers, a finding that could unleash a wave of lawsuits against U.S. hospitals, a researcher warned on Wednesday.
According to a study in this week's New England Journal of Medicine, medical interns who worked shifts lasting 24 hours or more were twice as likely to be involved in serious crashes after work than doctors who put in fewer hours.
Just as bartenders are now being held liable for accidents caused by drunk customers, hospitals, which routinely schedule interns to work double, triple or quadruple shifts, may soon find themselves sued for motor vehicle accidents caused by exhausted staff, one of the researchers said.
"The medical profession should be a leader in accident prevention, yet it's requiring its medical trainees to work marathon shifts and lets them drive home in this impaired condition in which they're unfit to drive," said Harvard Medical School's Charles Czeisler, a sleep expert. "That's akin to letting someone get behind the wheel when you know they're drunk."
Despite years of research showing sleep-deprived workers are more prone to errors, the U.S. medical community has been slow to cut back on trainees' hours.
The European Union has imposed a 13-hour limit on daily shifts for physicians, with some exceptions.
Marathon shifts
The study by Czeisler and his colleagues was based on a Web-based survey in which nearly 2,800 interns provided monthly reports of their work hours and documented any road crashes or near-miss incidents in which they were involved.
The researchers concluded a substantial number of accidents could be prevented if hospitals implement less rigorous work schedules for interns.
The new findings came two months after the Czeisler team found that sleep-deprived interns make 5.6 times more serious mistakes in the hospital than their rested colleagues.
An editorial in the journal said driving simulations have shown that people forced to stay awake for 19 to 21 hours are as impaired as people with blood alcohol concentrations of 0.05 to 0.08. Truck drivers aren't allowed behind the wheel with a level of 0.04 or above. The legal limit in most U.S. states is 0.08.
U.S. guidelines allow interns to work 30 consecutive hours every other shift.
The interns in the latest study averaged 32 hours per shift four times a month. In some training programs, the doctors had shifts lasting 48 to 84 hours.
Every extended work shift in a month increased the likelihood of an accident on the way home by 16 percentage points.
Among doctors who were required to be in the hospital for extended periods, the chance of falling asleep while driving more than doubled, and the chance of falling asleep while stopped in traffic nearly quadrupled.
The Czeisler team also warned that sleep-deprived doctors may face criminal prosecution for their accidents.
"Drivers in both the U.S. and Great Britain have been convicted of vehicular homicide for driving when impaired by sleepiness," they said.
New Jersey law says a person is guilty of reckless driving if he has gone without sleep for more than 24 hours. New York, Massachusetts and Michigan are considering similar legislation.
PROVIDENCE, Rhode Island (Reuters) -- Overworked, sleepy doctors-in-training who hit the road after work are as much a hazard as drunk drivers, a finding that could unleash a wave of lawsuits against U.S. hospitals, a researcher warned on Wednesday.
According to a study in this week's New England Journal of Medicine, medical interns who worked shifts lasting 24 hours or more were twice as likely to be involved in serious crashes after work than doctors who put in fewer hours.
Just as bartenders are now being held liable for accidents caused by drunk customers, hospitals, which routinely schedule interns to work double, triple or quadruple shifts, may soon find themselves sued for motor vehicle accidents caused by exhausted staff, one of the researchers said.
"The medical profession should be a leader in accident prevention, yet it's requiring its medical trainees to work marathon shifts and lets them drive home in this impaired condition in which they're unfit to drive," said Harvard Medical School's Charles Czeisler, a sleep expert. "That's akin to letting someone get behind the wheel when you know they're drunk."
Despite years of research showing sleep-deprived workers are more prone to errors, the U.S. medical community has been slow to cut back on trainees' hours.
The European Union has imposed a 13-hour limit on daily shifts for physicians, with some exceptions.
Marathon shifts
The study by Czeisler and his colleagues was based on a Web-based survey in which nearly 2,800 interns provided monthly reports of their work hours and documented any road crashes or near-miss incidents in which they were involved.
The researchers concluded a substantial number of accidents could be prevented if hospitals implement less rigorous work schedules for interns.
The new findings came two months after the Czeisler team found that sleep-deprived interns make 5.6 times more serious mistakes in the hospital than their rested colleagues.
An editorial in the journal said driving simulations have shown that people forced to stay awake for 19 to 21 hours are as impaired as people with blood alcohol concentrations of 0.05 to 0.08. Truck drivers aren't allowed behind the wheel with a level of 0.04 or above. The legal limit in most U.S. states is 0.08.
U.S. guidelines allow interns to work 30 consecutive hours every other shift.
The interns in the latest study averaged 32 hours per shift four times a month. In some training programs, the doctors had shifts lasting 48 to 84 hours.
Every extended work shift in a month increased the likelihood of an accident on the way home by 16 percentage points.
Among doctors who were required to be in the hospital for extended periods, the chance of falling asleep while driving more than doubled, and the chance of falling asleep while stopped in traffic nearly quadrupled.
The Czeisler team also warned that sleep-deprived doctors may face criminal prosecution for their accidents.
"Drivers in both the U.S. and Great Britain have been convicted of vehicular homicide for driving when impaired by sleepiness," they said.
New Jersey law says a person is guilty of reckless driving if he has gone without sleep for more than 24 hours. New York, Massachusetts and Michigan are considering similar legislation.
