Do Sleepy Medical Residents Jeopardize Patient Care?

But along with Wolfe, medical residents and sleep researchers said that's not the case. Harvard director of sleep medicine Chuck Czeisler MD, said "resident physicians working 30-hour shifts make 36% more serious medical errors caring for ICU patients, including 460% more diagnostic mistakes, than those scheduled to work 16 hours.

"They then have a 168% increased risk of a motor vehicle crash driving home from these marathon 24-hour shifts and are 73% more likely to stab themselves with a needle or scalpel when performing a procedure after working 20 hours than during a 12-hour shift," said Czeisler, who is also chief of sleep medicine at Brigham and Women's Hospital in Boston.

The IOM report's authors said that the institutions that sponsor the residency and fellowship programs could accomplish shift reductions by having salaried personnel, or technicians, do many of the functions that medical residents perform now. That kind of payroll change would cost $1.7 billion a year, or .4% of Medicare spending, the IOM panel said.

Czeisler said those dollars would easily be saved because the reduction in work-related fatigue among residents would prevent at least 10% of the medical errors they now make, errors that cost the hospital far more in prolonged patient care.

Art Levin, director of the Center for Medical Consumers and a reviewer of that IOM report who participated in the Public Citizen campaign Thursday, said the current practice of forcing medical residents into long shifts leans on traditional practice.

"Unfortunately organized medicine often falls victim to the 'if it was good enough for me,' and 'that's the way we've always done it,' tracts. Well, it isn't good enough for the millions of patients who have or will suffer preventable harm. And the way we've always done has been lethal for many of those who came to the medical system for help and instead were harmed."

In launching the Public Citizen campaign, Wolfe introduced John Ingle, MD, regional vice president of the Committee on Interns and Residents with SEIU Healthcare.

"Life and death decisions should not be made by someone who is sleep-deprived," said Ingle, and a fourth-year ENT resident in Albuquerque. "I know that the public agrees. My patients are usually horrified when they found out that I have not slept since they had seen me the previous day.

"Even more horrifying, I know a chief resident who puts his car in park every time he stops at a stoplight on the way home from the hospital fearing that he will dose off and take his foot off the brake pedal."