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A paradox for young docs: New work-hour restrictions may increase, not decrease, errors
Date:3/25/2013

ing residency programs around the U.S. The research team then surveys these interns every three months throughout that first year, asking questions that gauge mental health, overall well-being, sleep habits, work hours and performance on the job.

By comparing the interns serving before the new ACGME rules (called the 2009 and 2010 cohorts) with the interns serving after the new rules were implemented (the 2011 cohort), the research team assessed the effects of the new duty hour rules.

In addition to the increase in self-reported medical errors, 20 percent of the residents screened positive for depression.

Sen was an intern in 2006, and in the years since has studied depression among medical students and residents, said he had been in favor of the adjusting duty hour rules in principle. "It was obvious that after working for 24 hours, we were not functioning at our best, and this was not optimal for us or the patients we were treating," he explains. But in practice, he says, the new rules may have had unintended consequences that ran counter to the goals of new guidelines.

In addition to "work compression", he says, residents now hand off responsibility for a long list of patients more frequently than in the past. Communication between the intern who is ending a shift, and the one beginning a shift, may not cover all patients in detail, he suggests, and this gap in communication may not become apparent until an urgent situation arises with one of the patients.

He also said the increase in errors may come back down with time. "The 2011 changes were a pretty radical shift," he notes. "Doctors have worked 30-hour shifts for decades, and it may just take time for all parts of the health care system to get used to the new rules and adjust."

But, he cautions, the new data don't definitively support any one of these theories as the culprit in the rise in error rates or the lack of progress in sleep hours and well-be
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
Source:Eurekalert

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