Key recommendations include:
- Limiting all resident work hours to shifts of 12 to 16 hours;
- Making ACGME work-hour compliance a condition of participation for Medicare graduate medical education support.
- Identifying in real time when a resident physician's workload is excessive and additional staff should be activated;
- Requiring attending physicians to supervise all admissions;
- Mandating in-house supervision for all critical care services, including emergency, intensive care and trauma services;
- Making fatigue management a Joint Commission National Patient Safety Goal. The recommendations note that "fatigue is a safety concern not only for resident physicians, but for nurses, attending physicians and other healthcare workers."
- Redesign resident workload requirements to maximize educational value. Much of what residents currently do – drawing blood, filling out paperwork and starting intravenous lines adds to their heavy workload and is more appropriately done by other hospital personnel.
- Provide transportation to all residents who are too tired to drive home. In addition, hospitals should provide transportation for all residents who, for unforeseen reasons or emergencies, work consecutively for more than 24 hours.
- Include moonlighting in work hour limits. Hospitals should establish formal policies on moonlighting and actively monitor resident physician moonlighting.
Medicare pays more than $9 billion a year to academic medical centers, which is used to cover residents' salaries. The report's authors said that re-designing training to eliminate dangerously long shifts, waste and inefficiency will produce savings that will help to offset the cost of hiring additional personnel if they are needed.
The article is available here.
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John Commins is a senior editor with HealthLeaders Media.