Smiley & Smiley, LLP

Resident hour restrictions for patient safety may be backfiring

A few years ago, a medical oversight board took action it believed would help reduce medical error rates among young physicians pursuing their residencies. In a dramatic shift away from traditional “sink or swim” teaching practices, the oversight board reduced the number of hours residents could work without sleep from 30 hour shifts to 16 hour shifts. The medical community has been in disagreement ever since about whether or not this move constitutes both appropriate and positive change overall.

Two recent studies suggest that this action may actually be fueling medical malpractice claims rather than preventing them. Each was recently published in the Journal of the American Medical Association and each is receiving wide attention from safety experts and physicians generally. The consensus seems to be that the policy needs to be reformed in light of new evidence.

The logic behind the policy shift rests primarily on the idea that well rested doctors will make fewer fatigue-related patient safety errors. However, the study conducted by experts at the University of Michigan indicates that error rates have risen an astonishing 15 to 20 percent among residents working these newly mandated shorter shifts.

The reasons for this sharp spike in error rates are not immediately clear. However, one theory suggests that residents are being asked to accomplish a greater amount of work over shorter shifts in order to compensate for “time lost” under the new policy. Rushing through tasks and mounting pressure to learn in shorter periods of time may be making residents more prone to preventable accidents.

If the purpose of the policy shift was indeed to protect patients from negligent residents, then the oversight board needs to reevaluate what actually makes these residents tick. Once a proper balance between rest and pressure is struck, physicians will ideally be able to learn without harming their patients unnecessarily.

Source: USA Today, “Studies: Residents make more errors on shorter shifts,” Janice Lloyd, March 25, 2013

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