Fatigued Medical Residents Make Errors
Unfortunately it happens every day in America’s hospitals. In 2000, Lewis Haskell, 15 was hospitalized for elective surgery. Four days later he died from “failure to rescue,” a failure to recognize his failing condition by hospital personnel. His doctor was a first-year medical resident and had been working more than 30 hours when the teenager died. That is not uncommon. Medical residents routinely work 30 hours shifts straight and must work them about 10 times a month. Their chronic fatigue obviously has the potential to lead to errors.
A Harvard Work Hours, Health, and Safety Group at Brigham and Women’s Hospital, reports that one in five resident physicians say they have made a mistake that resulted from fatigue that injured a patient.
Haskell’s mother, Helen, has now joined forces with Public Citizen, the nonprofit consumer group, to establish Mothers Against Medical Error. The group is garnering support to lower the number of hours required that physicians work in any one shift. Dr. Sidney Wolfe of Public Citizen says “few, if any, people would fly on a plane whose pilot had been awake and working for 25 to 30 hours. Federal regulations prohibit pilots from flying more than 30 to 35 hours a week.”
The group has formed a Web site, and there people share stories of medical errors as well as get information. More than 40 organizations have sign a petition so far calling for the shorter shifts and more oversight of resident physicians. Other groups advocating for shorter resident hours include the Committee of Interns and Residents, SEIU Healthcare, and the American Medical Student Association, among others.
This recommendation has been heard before. In December 2008, the Institute of Medicine in a report “Resident Duty Hours: Enhancing Sleep, Supervision and Safety” also suggested residents have more supervision and that their shifts be significantly reduced from 30-hours to 16 hours or fewer. Additionally IOM found that residents on shorter shifts made 26 percent fewer serious medical errors and were more likely to learn new things on their shift than those who were sleep deprived.
Public Citizen picked up the ball even earlier in 2001, petitioning the federal agency that oversees workplace safety, OSHA (Occupational Safety and Health Administration) to reduce shifts for residents. Unfortunately the group that sets the standards for the training of physicians in the U.S., the Accreditation Council on Graduate Medical Education, convinced OSHA not to make any changes. Since hospital shifts do not fall under federal work rules, it is difficult to force them to adhere to outside imposed standards.
Often experienced doctors complain that they had to undergo long shifts when they were residents and that contributes to some of the resistance. Then there is the cost. Obviously with fewer working hours, hospitals will have to hire more doctors. The IOM estimates the additional cost at $1.7 billion per year. But consider the cost savings in fewer medical errors not to mention lives saved and the shift to fewer marathon hours worked by medical residents just makes sense.
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