A new report from the Institute of Medicine proposes revisions to medical residents’ duty hours and workloads to decrease the chances of fatigue-related medical errors and to enhance the learning environment for these doctors in training, according to a press release from the National Academies. The report does not recommend further reducing residents’ work hours from the maximum average of 80 per week set by the Accreditation Council for Graduate Medical Education (ACGME) in 2003, but rather reduces the maximum number of hours that residents can work without time for sleep to 16, increases the number of days residents must have off, and restricts moonlighting during residents’ off-hours, among other changes.
Altering residents’ work hours alone, however, is not a silver bullet for ensuring patient safety, stressed the committee of medical and scientific experts that wrote the report. The committee also called for greater supervision of residents by experienced physicians, limits on patient caseloads based on residents’ levels of experience and specialty, and overlap in schedules during shift changes to reduce the chances for error during the handover of patients from one doctor to another.
Financial costs and an insufficient health care workforce are the biggest barriers to further revising resident hours, the report notes. It calls for additional funding for teaching hospitals, estimating that the additional costs associated with shifting some work from current residents to other health care personnel or additional residents could be in the ballpark of $1.7 billion per year.
"Fatigue, spotty supervision, and excessive workloads all create conditions that can put patients' safety at risk and undermine residents' ability to learn," said committee chair Michael M.E. Johns, chancellor, Emory University, Atlanta. "Health care facilties can create safer conditions within the existing 80-hour limit by providing residents regular opportunities for sleep and limiting extended periods of work without rest. But these steps should be supplemented by additional efforts to improve patient safety and ensure residents get the full experience they need to safely and competently practice medicine at the end of their training."
Additional information on Resident Duty Hours: Enhancing Sleep, Supervision, and Safety can be found at
http://www.iom.edu/residenthours. Copies of the report are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet athttp://www.nap.edu. In addition, a podcast of the public briefing held to release this report is available athttp://national-academies.org/podcast.
Recommendations for medical residents aim to improve patient safety (12/5)
December 5, 2008