Wednesday, April 17, 2013

Human Performance: Resident Physician’s Shorter Shift Increases Patient Risk

A recent study done by Johns Hopkins researchers concludes that “limiting the number of continuous hours worked by medical trainees failed to increase the amount of sleep each intern got per week, but dramatically increased the number of potentially dangerous handoffs of patients from one trainee to another”.

The researchers also found that, “the minimal number of patient handoffs between interns increased from three for those working 30 hours to as high as nine for those working 16-hour shifts. The more handoffs, the less continuity of care and the more room for medication and other treatment and communication errors, past research has shown. Meanwhile, the minimal number of different interns caring for a given patient during a three-day stay increased from three to as high as five. Whether or not, or in what way, that affects patient care or patient satisfaction is another unknown.”

Interestingly enough, this study also found that “although interns on the 16-hour limit schedule did sleep an average of three hours longer during the 48 hours encompassing their on-call period than those working 30-hour shifts, there was no difference in the amount of sleep they got across a week.”

"During each call period, the interns had 14 extra hours out of the hospital, but they only used three of those hours for sleeping."

Primary researcher Dr. Desai stated "we don't know if that's enough of a physiologically meaningful increase in sleep to improve patient safety".

Basic human factors knowledge suggests that human performance improves when the human body is in good physical condition—in this case sufficient sleep or a shorter shift—and allows for better decision-making and an improvement in safety and health.

However the study continues to suggest that the increases in the number of patient handoffs contribute to “the less continuity of care and the more room for medication and other treatment and communication errors”. If this is the case, shouldn’t the solution instead be one that consists of a better shift configuration, rather than reverting back to long shifts?


Reducing work hours for medical interns increases patient 'handoff' risks.
Doctor Fatigue Raises Car Accident Risk: Study, 12/26/2012.
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