If the Accreditation Council for Graduate Medical Education (ACGME) has their way, first-year residents will be “allowed” to (meaning, they will be told they must) work shifts as long as 28 hours—more than one entire sunrise-to-sunrise day. Currently, residents’ hours are capped at 16 hours per shift and 80 hours a week; the latter would not change with the new proposal. However, the reduction to 16 hours was implemented in 2011 because of a tide of evidence confirming a greater likelihood that residents make more patient errors when they are sleep-deprived.
It makes sense that a serious lack of sleep would lead to errors. Think about it: Would you want to make a decision about someone’s diagnosis and treatment—knowing the consequences could be life-or-death—if you hadn’t slept for more than an entire day? Many of us would barely be able to function after 28 hours straight of working any job, let alone a stressful one involving others’ lives.
What the Studies Show
A 2007 report from the Joint Commission Journal on Quality and Patient Safety drew the following conclusions after three years of studies. Doctors in training (which is what residents are) were found to demonstrate deteriorated performance when scheduled with recurring 24-hour shifts:
- They made 36 percent more serious errors in judgment than those who work only 16 hours.
- They were responsible for five times as many significant diagnostic errors.
- They experienced twice as many failures to pay attention overnight.
- They suffered a decrease in performance equal to those with a blood alcohol level of 0.05 percent to 0.10 percent. For comparison, 0.08 percent is considered legally drunk when driving.
- They made three times as many fatigue-related errors in medical judgment that led to a patient’s death.
- The residents themselves were also more likely to experience harm. They had twice as much risk of a vehicular crash driving home after 24 hours of work. They were also 61 percent more likely to suffer a needlestick or other sharp injury after 20 consecutive work hours.
Some groups are resisting ACGME’s proposal, because it brings into question both patient safety and the well-being of the doctors-in-training. Some of the critics include the American Medical Student Association, which delivered a petition with 67,000 signatures on it to the ACGME in early February of 2017.
And, before you object by saying that this sort of extra effort is needed because of the high cost of health care, know this: Medical centers offering residency programs receive government funds—that’s right, your tax dollars—of about $130,000 annually for each resident. Residents are then paid $50,000 to $60,000 annually. The teaching hospitals and medical centers are making money on residents.
Meanwhile, think about what hazards you might encounter should you end up in an emergency room at 4 a.m. with a first-year resident in his 28th hour of work. Would you really want to risk it? Or would you decide you weren’t really that sick?
Other Factors to Consider
As of 2014, we now limit airline pilots, who often have hundreds of lives in their hands, to flying eight to nine hours consecutively. These same regulations also require that pilots get at least 10 hours of rest in between shifts. Shouldn’t residents, the doctors-in-training most likely to take care of us in the hospital beyond business hours, get adequate rest, for all our sakes?
The ACGME is expected to make a decision in the coming weeks about the new, extended hours of residents. Let’s hope they take all factors into consideration, but especially patient safety.
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Our attorneys can help you evaluate your case; protect your legal right to the courts, stand by your side throughout the legal process, and get you the best possible results. For a free consultation, call the Columbia medical malpractice lawyers at Louthian Law Firm today at 1-803-454-1200, or fill out our confidential online consultation form.