But those rules are widely flouted, according to surveys of medical residents cited in this latest study.
In December, the influential Institute of Medicine (IOM) issued a report calling for greater adherence to the guidelines, increased supervision of residents, more attention to patient hand-offs and even shorter shifts. Among the most significant recommendations: shifts no longer than 16 hours or as long as 30 hours if residents were given five hours of protected nap time.
The IOM, however, can only make recommendations. It's up to the ACGME to enact the rules, which it has so far not done.
In the NEJM study, Nuckols and her colleagues estimated the cost of adopting the IOM recommendations at $3.2 million annually per major teaching hospital.
The total would range from $1.1 to $2.5 billion, depending on how much it cost to hire substitute providers such as physicians assistants, nurse practitioners or other physicians to cover shifts and how many costly patient injuries could be averted.
The increase in costs to hospitals would be substantial. The annual funding for U.S. graduate medical education was about $18.7 billion in 2006, according to a RAND study.
The stakes for society, which bears the costs of disability payments and lost productivity for patients injured by medical errors, are even higher, Nuckols said.
If patient errors declined by 10 percent as a result of adopting the recommendations, the additional cost for each patient admitted to the hospital would increase by only $17. If patient errors increased by 10 percent, cost per patient admission would rise $266.
Dr. Albert Wu, a professor of health policy and management at Johns Hopkins University, said research has suggested doctors who are tired have less patience, show less compassion and are more likely to discharge patients too soon.
Yet, there are also risks associated with handing off pati
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