Overall, Dr. Shonka concluded that no significant improvement occurred in the metrics we measured as a result of these regulations. In general, problems such as medical errors can still occur and some studies have shown no change in patient outcomes. Additionally, resident burnout continues to be a problem. He cautioned that the current study did not evaluate resident burnout or quality of life, and duty hour regulations may not be the entire story.
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February 2009IOM Issues Duty Hour Recommendations
The Institute of Medicine of the National Academies (IOM) recently released its recommendations on duty hours. It suggests an increase in the number of mandatory days off, restricts moonlighting during off-hours, suggests changes to the length of shifts-and much more.
The report acknowledges that altering residents’ work hours alone will not guarantee patient safety, but it could substantially reduce errors by reducing fatigue. It suggests that there should be greater supervision of residents by experienced physicians, and that there should be limits on patient caseloads according to residents’ levels of experience and specialty. It also suggests that centers need to ensure that there is a sufficient overlap of time during shift changes to ensure that the handing over of patients from one doctor to another goes smoothly.
The report does not recommend a greater reduction in work hours from the maximum 80 hours set by the ACGME. However, it does acknowledge that there is no single model of schedule that will fit all training facilities or specialties. To address this, the IOM offers two options for extended shifts, and keeps the choice of working up to an 80-hour averaged workweek.
The IOM notes that a lack of adherence to duty hour limits is common and underreported. There should be changes to ACGME monitoring such as unannounced visits and strong whistle-blowing processes to encourage resident reporting of violations, and pressure to work too long, the report says.
As for education-related issues, the report recommends keeping patient loads for residents at more manageable levels by reducing the number of non-education-related burdens on residents and improving supervision of residents with more frequent consultations between residents and their supervisors.
The committee recommends that Residency Review Committees (RRCs) set specialty-specific guidelines for the number of patients residents should be permitted to treat during a shift, based on the level of residents’ competency and patient characteristics.
The report attempts to help change the culture around error detection. It recommends that residents should be taught error detection, correction, reporting, and monitoring so they can participate fully in the hospital’s quality improvement efforts.