Healthcare News & Insights

Reducing residents’ work hours doesn’t improve patient care

It would seem to make sense that if your resident physicians worked fewer hours, they’d get more sleep,  learn more, do a better job, be happier and not be a risk to your patients. However, recent studies have proved that theory wrong.

Sleeping young female physicianConcern for the lack of sleep among doctors in training has been an issue for years and years.

It led the Accreditation Council for Graduate Medical Education (ACGME) in 2003 to restrict the number of hours first-year residents could work to a maximum of a 30-hour shift. Then in 2011, it changed the restriction to a maximum of a 16-hour shift.

Unfortunately, neither restriction seems to have done what was intended:

  • get interns more sleep
  • reduce the number of self-reported medical errors
  • decrease depression, and
  • provide more time for education.

Resident studies

The first study, by Dr. Srijan Sen and colleagues from the University of Michigan in Ann Arbor, analyzed surveys from 2,300 first-year residents in 51 programs in 2009 and 2010 before the 2011 regulations went into effect, and again after the rule change.

What the researchers found was that residents’ weekly on-duty hours only dropped slightly — from 67 hours to 64 hours — after the 2011 changes were in place. And as far as sleep and general well-being went, residents reported no improvements.

One factor that did change was the proportion of residents who said they’d made a serious error in the past few months. It rose from 20% to 23%.

Another study, by Dr. Sanjay Desai and colleagues from Johns Hopkins University in Baltimore, randomly assigned its residents to work shifts that followed the 2003 or 2011 rules.

While they found the 2011 schedule allowed for more consistent sleep patterns among residents, nurses and the interns involved in the study both reported a reduced quality of care due to more hand-offs between residents, which rose from 130% to 200%.

In addition, the residents following the 2011 guidelines spent less time during daylight hours working in the hospital, and therefore admitted fewer patients than those residents following the 2003 rule.

This study was stopped early due to the findings of the diminished quality of care.

Back to the drawing board

Obviously, different strategies have to be implemented to improve the education of residents and patient care.

One suggestion from the authors of the study is implementing work schedules for residents that take into account natural circadian rhythms.

Another suggestion was to increase funding for additional clinical staff. The thought process is with shorter work-shift hours residents are having to squeeze 24 hours of work into 16 hours. Also, if residents aren’t at the hospital due to shorter shifts, someone has to pick up the slack — and most hospitals can’t afford to hire new staff to handle the work that’s not being done.

The results of the studies were published in  JAMA Internal Medicine.

(Image courtesy of imagerymagestic/FreeDigitalPhotos.net)

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