MSHQ 039 : Resident Duty Hours and the Ripple Effect

Session 39

Session 39

In this episode, Ryan and Allison discuss a controversial topic, which is huge in residency today, specifically the residency work hour restrictions.

Even if you're still a premed, you need to understand that the amount of time residents work currently is much less than it used to be. As the house staff, residents practically live in the hospital to be able care for the patients.

A brief history of the Libby Zion Law

  • Switch to 36-hour work shifts until in 1984 when a patient Libby ZIon died in New York
  • Two years later, the courts ruled that her death was the cause of resident fatigue from the 36-hour shifts and a lack of oversight from attending physicians.
  • As a result, that state of New York has put a limit on resident work hours.
  • ACGME, the oversight body for all residencies in the US has also put a work hour restriction for everybody to where there is just an 80-hour averaged workweek for all residents and fellows.

Recently, that has been changed to 16-hour max workdays for interns with no overnight call, a 24-hour patient care and 4-hour transition of care period for residents.

So you would expect a decrease in medical errors now that residents are more rested, right?

Wrong.

An article in the New Yorker about Why Doesn't Medical Care Get Better When Doctors Rest More as well as lots of research coming out actually suggest that the work hour restrictions are actually not increasing patient care results. In fact, there is an increase of medical errors reported by residents.

Here are the highlights of the conversation with Ryan and Allison:

Sleep deprivation is an underappreciated problem:

  • A cause of cognitive impairment
  • Obstructive sleep apnea is associated with increased risk of stroke, heart attack, and other serious medical problems
  • Just as dangerous as drinking and driving since your judgment will be severely impaired
  • Increased risk of driving accidents

The consequences of the changes in work hour restrictions:

More handoffs

Patient handoff is when a physician currently working in a hospital hands off the patient and patient care to another physician that's coming in to take over for that patient to replace that physician so he/she can go home and sleep.

  • The covering doctor doesn't know the story or what happened the course of the hospital stay
  • They only get snippets of to-do items left over from the list
  • Lack of contacts
  • Patients and families are meeting more physicians. Physicians are knowing their patients less and vice versa. Unfortunately, the patient-family dynamics that you get to learn is not part of the handoff.
  • Doctor-patient relationship is broken down due to the lapses in the continuity of care

The change in education of residents, interns, and medical students

  • Disrupted rounds
  • Interns and medical students lose out on the attending physician's expertise and teaching
  • Not seeing the evolution of illness

The ripple effects:

  • Less hours working, more hours resting
  • Hospital's struggle to have same number hours a day and same amount of work with less people to work those hours and
  • Increase cost to hospitals with a Huge rise in the need for assisted healthcare professionals, PAs
  • Decrease in hours, increase in errors

Links and Other Resources:

Why doesn't medical care get better when doctors rest more?

A brief history of duty hours and resident education

Libby Zion Law

Doctors-in-training spend very little time at patient bedside, study finds

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  • austin newsam

    Hey guys, in addition to your regular format I really enjoyed this one. I’m a premed but being aware and cognizant of current medical issues is a must… Especially for medical school interviews I presume.