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Long-time concerns for patient safety and lack of sleep among medical residents prompted the Accreditation Council for Graduate Medical Education (ACGME) to reduce the continuous duty hours from 30 to 16. However, a study in this week’s JAMA Internal Medicine suggests that these hours have led to increased patient handoffs – and a decrease in quality of care, according to nurses and the residents.
In the study, researchers from Johns Hopkins University School of Medicine assigned 43 residents to one of three different models: a 2003-compliant model of being on call every fourth night, with a 30-hour duty limit, a 2011-compliant models of being on call every fifth night but working only 16 hours straight, or a night float schedule, in which residents worked a regular night shift week with shifts not exceeding 16 hours. The researchers found that the number of patient handoffs among the 2011-compliant group increased to as high as nine from just three in the 2003-compliant group. The number of interns caring for patients also increased from three to five. Nurses and residents alike reported such a perceived decrease in quality of care in the night float model that it was stopped early.
It was also found that training and educational opportunities were missed on the 16-hour model due to residents not being present during daytime hours.
A similar from Srijan Sen, MD, and colleagues appears in the same issue. Sen and colleagues looked at surveys of 2,300 residents in 51 medical programs and compared responses from 2009 to 2010 and after the new regulations took effect in 2011. The researchers found no significant changes in sleep hours, depressive scores, or well-being scores despite the reduced working hours. They also found that the percentage of interns who reported concern about making a serious medical error increased from 19.9% to 23.3% The researchers also found that many interns were expected to do 24 hours of work in a 16-hour time span.
"Despite the best of intentions, the reduced work hours are handcuffing training programs, and benefits to patient safety and trainee well-being have not been systematically demonstrated,” says Sanjay V. Desai, MD, lead author of the Johns Hopkins study.