Will Shorter Shifts in Residency Reduce Medical Mistakes?

February 25, 2013

It's likely no surprise that studies show physicians, especially those in residency, are often sleep-deprived and, when extremely fatigued, more prone to committing medical mistakes. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) limited residents to working 80 hours per week; in 2011, the group prohibited first-year residents from working 24-hour shifts. But will these changes ultimately prevent medical malpractice, or create new problems?

Sleep experts have found that after only a few days of sleep deprivation, a subject's mental abilities decline, response times slow, and cognitive performance decreases. It's frightening to imagine how a decrease in attention, memory, or coordination could affect a physician's ability to provide optimum care, and how easily medical mistakes could be made. For these reasons, some doctors are advocating for shorter shifts for residents.

A study in the New England Journal of Medicine found that first-year residents in an intensive-care unit made five times more serious medical errors while working a traditional (24 hours or more per day) schedule than those working a reduced shift. Another study performed by the Harvard Work Hours Health and Safety Group at Brigham and Women's Hospital in Boston found that first-year residents in an intensive-care unit working 24-30 hour shifts made 36% more serious medical errors than those working 16-hour shifts.

While these statistics are compelling, other doctors argue that reducing residents' hours will detract from the quality of care provided. Restricting time spent in the hospital will decrease the young doctors' opportunities to see or operate on cases, providing fewer of the learning experiences that contribute to a comprehensive base of knowledge. Shorter shifts also mean an even greater occurrence of patient "hand-offs." Residents typically spend 60-90 seconds passing patient information to the incoming physician--more shift changes could lead to more chances for communication gaps or misinformation that could lead to an increase in preventable medical mistakes and, by extension, medical malpractice lawsuits.

The ACGME itself found, in a study done after the 2003 standards were implemented, that there was little to no difference in the number of errors reported by programs who had made significant reductions in resident hours and those who had not. Doctors on both sides of the issue agree that the safety of both patients and physicians should be taken into account when determining optimal working hours. Most also agree that a system that optimizes learning opportunities, improves communication, and produces well-educated, innovative doctors is the best way to prevent medical mistakes. However, there is no question that a doctor suffering from extreme fatigue is more likely to make a mistake than one that is not. After all, a resident's education, which include includes extended hours of training, should never trump patient safety.

Sources:
The Wall Street Journal, "Should Medical Residents Be Required to Work Shorter Shifts?", 2-18-13

The Wall Street Journal, "The Experts: Are Medical Residents Dangerously Exhausted?", 2-22-13

U.S. Dept. of Health & Human Services; Agency for Healthcare Research and Quality (ARHQ), Making Health Care Safer: A Critical Analysis of Patient Safety Practices, Viewed 2-25-13