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Young doctors still too tired for safety

Discussion in 'Emergency Medicine' started by Hawk22, Dec 3, 2008.

  1. Hawk22

    Hawk22 Senior Member
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    Not sure if you guys saw this today or not, but I thought it was interesting.

    From the Associated Press:

    "Report: Young doctors still too tired for safety"

    "WASHINGTON (AP) — Doctors-in-training are still too exhausted, says a new report that calls on hospitals to let them have a nap. Regulations that capped the working hours of bleary-eyed young doctors came just five years ago, limiting them to about 80 hours a week.

    Tuesday, the prestigious Institute of Medicine recommended easing the workload a bit more: Anyone working the maximum 30-hour shift should get an uninterrupted five-hour break for sleep after 16 hours.

    At issue is how to balance patient safety with the education of roughly 100,000 medical residents, doctors fresh out of medical school who spend the next three to seven years in on-the-job training for their specialty. 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. So in 2003, the Accreditation Council for Graduate Medical Education issued the first caps. Before then, residents in some specialties could average 110 hours a week.

    The government asked the IOM to study the current caps. Violations of current limits are common and 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 if the caps helped that problem, the report said.

    So it also recommends:

    _Experienced physicians should more closely supervise residents.

    _Better overlap of schedules during shift changes to reduce chances for error as one doctor hands patients' care over to the next.

    _Increase mandatory days off each month, and extend hours off between shifts depending on how long the resident worked, during day or night.

    The accreditation council didn't immediately say if it would follow the recommendations."

    http://www.google.com/hostednews/ap/article/ALeqM5i9URKPpxtJyLV1lPOtKdCX7QC79QD94QR38G0


    I'm don't think it is currently feasible to have 5 hours off after working or being on call for 16 hours, but it sure would make my call nights better. :)


    Here's a link to the actual IOM report:
    http://www.iom.edu/CMS/3809/48553/60449.aspx
     
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  3. GeneralVeers

    GeneralVeers Globus Hystericus
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    While I agreed with the 80 hour work-week rule, I don't agree with the new regulations. As it is, just meeting RRC requirements plays havoc with scheduling. Further restrictions would make it near impossible to maintain compliance. I'm mainly talking about other specialties, not EM.
     
  4. tybalt

    tybalt I think I'm hilarious.
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    Agreed. Can you just imagine how long residencies would have to become??? Also, what would have to happen -- another type of "short call" where a team comes on to cover the on-call team while they are on their 5 hour nap?

    I know that residencies are tiring, and I know that I definitely would crash the second I got home from a 30+hour straight shift in the MICU that also involved a marathon in the middle, but I also know that I learned so much and that while I was running around, I felt sharp and awake. (Yes, I know there are studies contradicting this).

    We're all turning soft! Back in my day, we worked 3 30 hour shifts in one day! Then we walked up hill in the freezing snow both ways to work and home.
     
  5. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD
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    Lots of hospitalists do shift work now. I don't see why residents couldn't. When I was on trauma the mid-level and senior residents were on 12 hours, off 12 hours, 6 days a week. I don't see why they couldn't do that with the interns too.

    Specialties without a lot of residents would suffer more, of course. I mean, who wants to be the ENT guy on nights?
     
  6. Dakota

    Dakota Senior Member
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    This would be a nightmare. There isn't space around most hospitals to add extra on-call rooms/beds. Imagine working a regular call schedule, except now you have to go home (no place to sleep in the hospital) for 5 hours in the middle of the night (say midnight to 5am) . . . and another team has to come in to cover the midnight to 5am shift. You then arrive back in the hospital at 5am to cover until the day's team gets on at 7. Or perhaps you lose your post call day off. And you've doubled your number of call nights because now there's that pesky 12-5 shift . . . The 12pm-5amers, perhaps they get to go home for two hours before coming on again at 7? Ugh, talk about a scheduling nightmare.

    I'm sure this isn't what's intended, but ridiculous rules often spawn ridiculous work arounds.

    And who's to say this policy would be any better enforced. I mean, it's shocking that residents don't report work hour violations when the only outcome they can really expect is their program gets put on probation. The cherry on top is they also lose the respect of their attendings. Yup, that works out really well for the residents.
     
    #5 Dakota, Dec 3, 2008
    Last edited: Dec 3, 2008
  7. NeuroSync

    NeuroSync Every day is a good day
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    The article pointed out that such changes would necessitate hiring more people, to the tune of $1.7B annually.

    If such a change is endorsed, it could not happen for a while. It will be interesting to see how this all shakes out...
     
  8. Hawk22

    Hawk22 Senior Member
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    From what I understand after reading a few more articles on this, these are just recommendations and not actually rules that are likely to be implemented. As it is now, there's no way that most hospitals could give a resident 5 hour break in the middle of a call night without resorting to shift work schedules. In the end, they can propose and adopt all the regulations they want but residents will continue to just lie about their work hours and residencies will continue to look the other way for better or for worse.
     
  9. gutonc

    gutonc No Meat, No Treat
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    You know, my VA IM rotation had what was essentially a solution to this and it worked pretty well. We had a Q5 schedule with night float. Long call went until 8pm, NF showed up then and covered all new admits and cross-cover until 7am, 5 nights a week. The thing about the long call team was that they weren't expected to leave the hospital at 8pm. They were expected to finish admitting patients (who usually come until about 7:50pm), writing notes and orders, evaluating them and then either go home or go to sleep in the call room.

    In general, we finished up around 11p or midnight (sometimes as late as 1 or 2), signed out to NF and then went to sleep. We got up the next morning around 6 (or 5 if we went home rather than staying in-house), pre-rounded by 7, rounded with staff at 8 and were out of the hospital by noon or 1. They counted these shifts as 30h shifts and we were expected to hustle out of the hospital before 2pm. So we got "credit" for a 30h shift but generally worked more like 20-24 hours with a 4-6 hour break in the middle of it. It seems like this sort of a system would fairly easily address the new recs, at least in the IM/Peds/FM inpt setting. Surgical specialties would be a different kettle of fish. And EM will never have to deal with this after the first or 2nd year of residency on off service rotations.
     

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