Medical Errors and Resident Work Hours: When Mistakes are Made

I'm ready for a break from political discussions, so I thought I'd try out this topic.

As many of you know, I am doing my internship in internal medicine for a year in a major east-coast city. During the past year, a new set of work-hour rules were implemented that limited the amount of time we may be in the hospital to "24+6" hours on call and 80 hours a week averaged over four weeks. Call may not be more frequent than every third night.

Due to the medicolegal environment, I am fearful of discussing medical errors I have witnessed, even here, since it then becomes public knowledge, but I have seen several, and most of them have been related to fatigue.

The question I would like to pose for discussion is: should work hours be limited even more? Should calls last no more than 24 hours? Studies have shown that 24 hours of sleep deprivation impairs a human being to the same degree as having a blood alcohol level of 0.1%-the legal limit for drunk in most states. Certainly a resident who showed up drunk would be fired on the spot, yet the equivalent of intoxicated physicians-in-training are wandering around most US hospitals on a regular basis.

How to solve the problem? Should more changes be made? Should Congress get involved, as the changes we have now were made by the Residency Review Committee and not the government?

Discuss.

Peace,

V-03

 

I was under the impression that the new rules, even though they are well-intentioned, are goign to be almost impossible to enforce/administer. And that the '8 hours off' provision and several other parts of the new rules are either completely unworkable (due to scheduling, or the demands of following up on cases), or will cause massive scheduling/manpower difficulties.

After all, it's the residents and interns who do all the work, right?

 

It's actually 10 hours off between shifts, actually.

The reason I started this topic is that there has been much increased awareness in the media recently regarding medical errors. There have been strong calls for increased reporting but hospitals are reluctant to do this as long as there are no increases in protection from liability. A major source of errors are physicians-in-training, especially exhausted physicians-in-training. While there are some benefits to very long hours (such as inundation in the material that helps one learn by osmosis), the berefits far outweight the benefits. It's simply, for the most part, just a form of hazing.

The solution would be to hire more workers so that residents could take shifts, or be able to have shorter calls (such as 24 hours). The problem is, without Congressional action and government help, hospitals won't be able to take the kind of financial hit that hiring the extra residents would incur.

It's a difficult problem, and the solution is still elusive.

Peace,

V-03