Extended Work Hours Increase Risk of Harm, Regardless of Resident Physicians’ Experience Levels

Details

• Personal Author:
  Barger LK ; Czeisler, Charles A. ; Landrigan CP ; Weaver MD
• Description:
  The working hours of resident physicians have been controversial since William Stewart Halsted, a cocaine addict who became the first professor of surgery at Johns Hopkins Medical School in 1889, first required training physicians in the US to work unlimited hours. They were obliged to remain in the hospital 24/7 throughout their training years (hence the term "resident physicians"). Ever since the patient safety hazards associated with 24 hour shifts were first documented 50 years ago, multiple reforms have been attempted. In 2009, the National Academy of Medicine recommended a series of reforms for all resident physicians. However, the Accreditation Council for Graduate Medical Education (ACGME) failed to adopt most of these recommendations, such as the limit of four consecutive night shifts, 12 hours off following night shifts, and 24 hours off every week. Although the National Academy concluded that extensive evidence supported a 16 hour work-hour limit for all resident physicians, the ACGME only implemented the recommended limit of 16 consecutive hours caring for patients for first year (PGY1) resident physicians. PGY1 residents account for approx. 21% of resident physicians, so that nearly 80% of resident physicians could continue to work 28 hour shifts. The ACGME noted that most of the evidence on which the National Academy based its recommendations was came from PGY1 resident physicians, and posited that one year of experience would somehow overcome the adverse impact of fatigue on patient and occupational safety. ... The ACGME should implement evidence based comprehensive fatigue risk management policies that apply to all resident physicians, regardless of their experience. These policies should include safer work hour limits, screening for sleep disorders, and accommodations for those with disabilities and medical conditions that affect their ability to work non-standard hours. Those policies should limit weekly work hours and eliminate extended duration shifts. As the National Academy advised, resources are needed to avoid increases in workload when resident physicians work fewer hours. Medicare already provides $10-12bn annually to teaching hospitals for resident physician training. Rather than requiring new funding, Congress could restrict use of this funding for teaching hospitals that implement the safer limits for work hours recommended by the National Academy, and actually spend those currently unrestricted dollars on resident physician training rather than elsewhere. Restricting use of this funding that Medicare already provides for resident physician training would be sufficient to fund meaningful work hour reforms. Such reforms should include supporting unit clerks to assist resident physicians with burdensome paperwork and patient placement, implementing comprehensive evidence based handover programmes to reduce medical errors, hiring physician extenders to pick up work load as resident physician work hours are reduced, and providing comprehensive resident physicians with education in sleep health and screening for sleep disorders. The evidence shows that failure to do so will increase risks to both physicians in training and their patients. [Description provided by NIOSH]
• Subjects:
  Fatigue Health Personnel Occupational Health Safety Sleep Sleep Initiation And Maintenance Disorders Staff Development
• Keywords:
  Long Work Hours Physicians Sleep Deprivation Training Work Schedules
• ISSN:
  0959-8138
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Massachusetts ; OSHA Region 1
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  381
• NIOSHTIC Number:
  nn:20067389
• Citation:
  BMJ 2023 Apr; 381:p838
• Federal Fiscal Year:
  2023
• Performing Organization:
  Brigham and Women's Hospital, Boston, Massachusetts
• Peer Reviewed:
  False
• Start Date:
  20190901
• Source Full Name:
  BMJ: British Medical Journal
• End Date:
  20230831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:03a51aeb7442cadf675ee2e2a13f3a8ed188caaf45862a7432eff746fc09ec0cbe0d4aee82381b3c49ac2e3883d86cd43ad783259efe6c7c27ae40b9d84868d8
• Download URL:
  https://stacks.cdc.gov/view/cdc/231440/cdc_231440_DS1.pdf
• File Type:
  [PDF - 157.37 KB ]