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Medical Error Risk Rises Under Shorter Medical Intern Shifts

Cheryl Clark, for HealthLeaders Media, March 26, 2013

Desai drew these conclusions after setting up a three-month experiment that compared three work schedules for trainees, two of which used a 16-hour limit and one which used a 30-hour limit. They were:

  • On call every fourth night with a 30-hour duty limit, OR
  • On call every fifth night with a 16-hour continuous duty limit, OR
  • On a night float schedule with a 16-hour continuous duty limit

When Desai and colleagues analyzed the results, they realized that the lowest number of interns who cared for one patient during a three-day stay went from three to as high as five.

Additionally, educational opportunities suffered under the 16-hour limits. For starters, interns had fewer admissions in the two 16-hour schedules than in the 30 hour schedule, and more patients were cared for by each intern in the 30-hour schedule.

Other lost opportunities came from the reduced amount of time 16-hour-scheduled interns spent attending a daily noon conference, and reduced amount of time they spent attending and teaching rounds, compared with interns on a 30-hour schedule.

And even though trainees in the 16-hour limited work schedule were not supposed to exceed that, they did. Violations of the 16-hour rule occurred in 36% of one 16-hour group of trainees, and 16% of the other 16-hour group.

"Implementing the 2011 Accreditation Council for Graduate Medical Education duty hour regulations may present challenges and could have unintended consequences," the authors wrote. Although sleep duration did increase during the on-call period, the regulations did not lead to an increase in average sleep per day.

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2 comments on "Medical Error Risk Rises Under Shorter Medical Intern Shifts"


Steve Spear (4/7/2013 at 7:38 AM)
The key problem is not handoffs per se[INVALID]unless you argue that there should never be a handoff, they will occur[INVALID]it is that the handoff process is poorly designed to preserve hypotheses, data, interpretation, and recommendations one shift to the next. This is not an impossible problem as healthcare is not the only high risk setting (and not even the highest risk of those settings) in which the work progresses with cycle times far beyond human endurance. In other situations[INVALID]Naval nuclear propulsion, space flight, combat outposts, long haul civilian aviation, continuous industrial processes, etc.[INVALID]the handoff problem is well managed. Though risks are high, calamities are rare. The fundamental problem is that healthcare providers (particularly those most senior) continue to view training and treatment solely as expression of individual professional skill rather than recognizing the coordinating routines necessary for success. By the same logic, we would have no ballet or symphonies, only soloists, no relay racers, only individualists, and basketball would look like playground pickup. Steve Spear Sr. Fellow, Institute for Healthcare Improvement Sr. Lecturer MIT

Edward Framer, Ph.D. (3/27/2013 at 6:06 PM)
And there are a lot of us out here who have seen unreasonably long shifts also cause unnecessary injury and death. There is no excuse for 100-120 hour work weeks or for sloppy handoffs.