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New Report Recommends Strategies to Reduce Medical Resident Fatigue-Related Errors and Improve Training
Date:12/2/2008

urs. Lack of adherence to limits is common and often underreported. The IOM report recommends periodic independent reviews and strengthened protections for residents and others who report a lack of adherence to current work hour restrictions.

  • Stronger moonlighting restrictions. Current ACGME rules only count internal moonlighting (additional paid health care work at same health care facility) against the 80-hour weekly limit. The IOM report recommends internal and external moonlighting count against the 80-hour weekly limit, because moonlighting outside residency training affects strategically designed periods for rest and sleep, which could reduce residents' readiness for their primary duties.

  • Guaranteed days off to permit adequate recovery after working long shifts. The IOM committee said residents should receive a 24-hour break from duty each week, with one 48- hour break per month, for a total of five days off per month.
  • Reasonable on-call periods. The IOM committee said residents should be on call in the hospital no more than every third night.
  • Safe transportation provided by hospitals to residents who are too fatigued to drive home. AHRQ-funded research shows that residents more than double their risk of driving accidents when they drive home after working extended shifts.
  • Increased resident training on better communication during handovers. Handovers, when clinicians transition care responsibility to other health care providers, are likely to increase with shorter resident shifts. In some cases, multiple handovers could add to the risk for adverse events unless a structured team approach is used.
  • Increased involvement of residents in patient safety activities and adverse event reporting.IOM committee members suggest su
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SOURCE Agency for Healthcare Research & Quality
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