Medical Error Risk Rises Under Shorter Medical Intern Shifts
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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