Trying to establish a link between resident doctors’ work schedule and patient care, the IOM committee came up with some new recommendations. In an effort to ensure the safety and quality of work, they felt the trainee doctors should get 5 hours of sleep after working 16 hours. There has been concern that sleep deprivation and long working hours fogs their brain, leaving them exhausted, prone to making mistakes.
Michael Johns, chancellor, Emory University, Atlanta said, “Obviously anytime you get more rest in a shift, I think you know from a stand point it will make your life outside easier, patient care better and you can think more clearly.”
Other changes sought were, off-duty to vary according to timings and duration of shifts and increase in the number of days off from work, so that cumulative sleep loss is to the minimum. The committee called for supervision of residents by experienced doctors. Also, they recommend limits to be put on patient caseloads, depending on the resident doctor’s level of specialty. Another change in the offing was overlapping of schedules during shift changes, to reduce mistakes during handing over of patients from one doctor to another.
Dr Johns felt that, “Fatigue, spotty supervision and excessive workloads all create conditions that can put patient’s safety at risk and undermine resident’s ability to learn.”
The panel in its report to the Congress and Department of Health and Human Services went along with the proposal established by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 for residents to work for a maximum of 80 hours a week.
Dr Daniel Munoz of John Hopkins University of Baltimore revealed, “Our committees’ change was not to focus necessarily on longer scheduling or shorter scheduling, but smarter scheduling to try and identify the areas where we could have impact in preventing excessive fatigue acute and chronic, that might contribute to medical errors.”
The issue was to balance patient safety with education of 100,000 medical residents fresh out of med school who need to spend 3 to 7 years in on-the-lob training for specialty. “It ought to be rigorous. But it also ought to be humane and it ought to be safe for both patients and residents,” added Munoz.
Long duty hours negatively affect aspects of patient care, education and professionalism. The nature of medicine has changed dramatically. Technology is used consistently now. Instead of the doctor sitting at the patient’s bedside, these days they look at his chart which is a sea of numbers. The situation demands an alert mind.
Dr Ann Rogers of the University of Pennsylvania, School of Nursing in Philadelphia, a member of the committee, stated, “Cutting hours alone won’t do it, we need to pay attention on the work load. We need to pay attention on the supervision. The whole package will make a difference. Without it you could end up with a more stressed resident trying to do more work with lesser hours.”
Trimming the work load of residents means someone else to shoulder the responsibility. Assessing this shift, the cost of the process was estimated to be 1.7 billion dollars a year. Dr Michael Johns believed it was well worth it considering the expenditure incurred for medical errors. “We need to prevent the compression of the same amount of work into less time. Doctors in training should not have to sleep with their shoes on.”
Daniel Kirch, MD, president and CEO of Association of American Medical College said “We agree with the IOM that we must examine duty hours as one of the many factors in patient safety and quality of care. Putting the 2003 ACGHE standards into practice has been a complex undertaking. The planning and implementation of any further changes will require significant time and resources.”
The study was sponsored by the U.S. Agency for Health Care Research and Quality.
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