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Reduced hours lead to more mistakes by medical residents

In recent years, hospitals have become concerned about the number of hours that medical residents work. Doctors, researchers and healthcare experts have long believed that working long hours without rest impacts not only residents’ mental and physical well being, but also their ability to provide patients with the care they need. In order to address these concerns, in 2011, the medical oversight board at the University of Michigan Medical School reduced the number of hours a resident may work without taking a break from 30 to 16. A recent study of this change indicates, however, that these changes have not had their intended effects. In fact, cutting back on the number of consecutive hours that medical residents work appears to have increased the incidence of medical errors.

The study at issue, published recently in the Journal of the American Medical Association, found that the change to the shorter, 16-hour work day neither reduced rates of depression among medical residents nor caused them to get more sleep during the week, even though they had more free time. Even more concerning, residents who worked the shorter shifts committed medical errors that harmed patients 15 to 20 percent more often than those who worked longer shifts.

At first glance, the findings of the study seem counterintuitive. Experts are currently evaluating why these shorter working shifts caused a jump in errors, but two factors may be to blame. First, with residents working shorter shifts, patient “handoffs” increase. That is, as a resident goes off duty, he must pass responsibility for a patient’s care to another resident, who must take time to familiarize himself with each patient’s treatment information. Research indicates that these sorts of handoffs may lead to more medical errors. Second, the less time that residents are at work, the fewer the opportunities they have to receive critical training. Resident workload may also be to blame. Although the number of hours residents were allowed to work dropped, the amount of work they were expected to complete in that time stayed the same, leading to hurried, sloppy care.

The regulations governing the number of hours medical residents can work are set not by the federal government, but rather by the Accreditation Council for Graduate Medical Education. The Council is currently working to revise its guidelines, but this recent study may only complicate matters. To be sure, further research is needed to address the health of both medical residents and the patients they treat.