Medical Error Risk Rises Under Shorter Medical Intern Shifts

Cheryl Clark, March 26, 2013

The 2011 decision to limit from 30 to 16 hours the time hospital internal medicine trainees can continuously work may be making patients less safe, because it leads to far more hand-offs and perceptions by nurses and residents that quality of care suffers.

The new rules also didn't do what they were intended to accomplish, which was to significantly increase the amount of time trainees would sleep each week. Instead, only three of 14 hours in amount of time gained from work shifts is used for sleep, researchers say.

Those were among several findings of a Johns Hopkins University experiment that enrolled 43 house staff interns to various models of consecutive hourly duty limits during the early months of 2011. It is published in Monday's online edition of JAMA Internal Medicine.

"Handoffs, a known risk factor for medical errors, increased 130% to 200% in the experimental" groups, compared with the control group, although increased supervision and training of handoffs "may mitigate some of the threat," wrote Sanjay V. Desai, MD, assistant professor of medicine and lead author of the paper.

In a news release, he said "the consequences of these sweeping regulations are potentially very serious.

"Despite the best of intentions, the reduced work hours are handcuffing training programs, and benefits to patient safety and trainee well-being have not been systematically demonstrated," he said.

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