Doctors, Sleep, and Patient Safety
In 2011, the Accreditation Council for Graduate Medical Education (ACGME) limited first-year resident-physicians’ work hours to no more than 16 consecutive hours after studies indicated that longer shifts may increase risk of medical errors and other adverse outcomes.
The response to the limit was mixed and it was overturned in 2017, again allowing residents to be scheduled for up to 24 hours of continuous work.
A new study by Harvard Medical School researchers at Brigham and Women’s Hospital examines the impact of the 16-hour limit on the safety outcomes of patients directly under the care of resident-physicians.
Through national surveys of residents before (2002-2007) and after (2014-2017) the limit was enacted, the team found that resident-physician-reported medical errors and adverse events dropped by more than a third, and medical errors resulting in patient death declined by almost two-thirds when the 16-hour limit was in place. Results are published in BMJ Quality & Safety.
“We know that people are prone to make more mistakes when they are sleep deprived, and doctors are no exception,” said lead author Matthew Weaver, HMS instructor in medicine and associate epidemiologist at Brigham and Women’s.
“What’s important is that we can see that interventions such as work hour limits can have a meaningful effect. In our study, we saw a dramatic reduction in medical errors resulting in harm or leading to patient death when work hours were limited. It’s important that the risk of extended work shifts and the potential benefit of limits be transparent to patients and to providers,” Weaver said.
The authors conducted their national, prospective survey by reaching out to all U.S. medical school graduates and all additional individuals who matched to a U.S. residency program.
More than 21,000 agreed to participate, which represents nine percent of all U.S. medical residents from 2002-2007 and 18 percent of U.S. medical residents from 2014-2017.
After controlling for age, gender, specialty, and other variables, including time in patient care, the team found that after the work-hour policy was implemented, there was a 32 percent reduction in reports of significant medical errors, a 34 percent reduction in reported preventable adverse events, and a 63 percent reduction in reported medical errors resulting in patient death.
The authors note that the study is observational in nature and relies on self-reporting, which may be subject to recall bias and erroneous self-observation.
Read the whole article here.