Healthcare News & Insights

New research shows effect of long shifts on patient safety

Prevailing wisdom has always won out when it comes to new resident surgeons’ shifts – make them adhere to strict limits governing how long they can work. This move was made to keep patients safe. But according to new research, these limits may not be as effective as once thought. 

Medical team performing surgeryA news release from the American College of Surgeons explains why.

For years, resident surgeons have been prohibited from working shifts longer than 24 consecutive hours. New interns can only work 16 hours at a time. And after working a 24-hour shift, residents must take a specific number of hours off until they can work again. These rules were put into place over a decade ago to keep worn out residents from putting patients in danger.

But recent developments prompted giving this policy a second look – mainly, a growing understanding about the role patient handoffs play in safety and the continuity of care.

Researchers wanted to see if the constant staff changes caused by rotating surgery residents were more harmful to patients than having the same resident care for them for a longer time period after surgery.

Safety FIRST

To evaluate the effect of restrictive work hour policies on patient care, these researchers created a pilot study called the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial.

Residents who participated in the FIRST trial still followed three basic rules from the Accreditation Council for Graduate Medical Education (ACGME). Their workweek was limited to 80 hours, and they had to take one day off during each seven-day work period. Residents were also prohibited from being on call more than every third night.

But their hospitals were given the flexibility to make several changes to residents’ shifts. Both first-year interns and more experienced residents could work for longer time periods if necessary. Resident surgeons were no longer required to have at least eight hours off between shifts, and residents didn’t have to take 14 hours off after a 24-hour shift.

While on the surface, this change may seem like residents would work more hours, this wasn’t always the case. Researchers found that giving residents this flexibility made them rearrange their hours to be more effective at providing care. Shifts were longer, but the total number of hours they worked ended up balancing out.

And when comparing the residents in the FIRST trial to those who still worked standard hours, FIRST-trial residents were more likely to report better experiences regarding continuity of patient care and acquiring of operative skills. These residents were also more often present for the entire duration of an operation, which meant they were able to care for the same patients throughout their episodes of care.

In addition, residents participating in the FIRST trial didn’t feel any more dissatisfaction or stress than their peers who worked standard shifts, and they didn’t think fatigue had a negative effect on either personal or patient safety.

Most importantly, there were no negative effects on patient outcomes when residents were allowed to work longer shifts. The occurrence of death or other serious complications within 30 days of surgery was about the same for both residents who worked more flexible shifts and those who followed the more restrictive guidelines.

Being flexible

Even if your hospital doesn’t use surgical residents, this research is important because it demonstrates how working smarter during longer shifts can minimize the effects of provider fatigue on patient care.

Making sure surgeons and providers are using their time efficiently during long shifts can reduce the need for multiple patient handoffs and improve continuity of care. And this may reduce the likelihood of fatigue and burnout, which can both negatively affect patient care.

The research also shows the importance of allowing clinical staff the flexibility to work longer shifts, if needed, to avoid unnecessary disruptions in patient care. It’s key to balance flexibility with the freedom to take necessary time off to recharge after an episode of care is complete.

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