By Alexandra Sifferlin
Time
Originally published March 26, 2013
Giving residents less time on duty and more time to sleep was supposed to lead to fewer
medical errors. But the latest research shows that’s not the case. What’s going
on?
Since 2011, new regulations restricting the number of continuous hours
first-year residents spend on-call cut the time that trainees spend at the
hospital during a typical duty session from 24 hours to 16 hours. Excessively
long shifts, studies showed, were leading to fatigue and stress that
hampered not just the learning process, but the care these doctors provided to
patients.
And there were tragic examples of the high cost of this exhausting schedule.
In 1984, 18-year old Libby
Zion, who was admitted to a New York City hospital with a fever and
convulsions, was treated by residents who ordered opiates and restraints when
she became agitated and uncooperative. Busy overseeing other patients, the
residents didn’t evaluate Zion again until hours later, by which time her fever
has soared to 107 degrees and she went into cardiac arrest, and died. The case
highlighted the enormous pressures on doctors-in-training, and the need for
reform in the way residents were taught. In 1987, a New York state commission
limited the number of hours that doctors could train in the hospital to 80 each
week, which was less than the 100 hour a week shifts with 36 hour “call” times
that were the norm at the time. In 2003, the Accreditation Council
for Graduate Medical Education followed suit with rules for all programs that
mandated that trainees could work no more than 24 consecutive
hours.
The entire article is here.
