Medical Error Risk Rises Under Shorter Medical Intern Shifts

Cheryl Clark, for HealthLeaders Media , March 26, 2013

The 2011 decision to limit from 30 to 16 hours the time hospital internal medicine trainees can continuously work may be making patients less safe, because it leads to far more hand-offs and perceptions by nurses and residents that quality of care suffers.

The new rules also didn't do what they were intended to accomplish, which was to significantly increase the amount of time trainees would sleep each week. Instead, only three of 14 hours in amount of time gained from work shifts is used for sleep, researchers say.

Those were among several findings of a Johns Hopkins University experiment that enrolled 43 house staff interns to various models of consecutive hourly duty limits during the early months of 2011. It is published in Monday's online edition of JAMA Internal Medicine.

"Handoffs, a known risk factor for medical errors, increased 130% to 200% in the experimental" groups, compared with the control group, although increased supervision and training of handoffs "may mitigate some of the threat," wrote Sanjay V. Desai, MD, assistant professor of medicine and lead author of the paper.

In a news release, he said "the consequences of these sweeping regulations are potentially very serious.

"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," he said.

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2 comments on "Medical Error Risk Rises Under Shorter Medical Intern Shifts"

Steve Spear (4/7/2013 at 7:38 AM)
The key problem is not handoffs per se[INVALID]unless you argue that there should never be a handoff, they will occur[INVALID]it is that the handoff process is poorly designed to preserve hypotheses, data, interpretation, and recommendations one shift to the next. This is not an impossible problem as healthcare is not the only high risk setting (and not even the highest risk of those settings) in which the work progresses with cycle times far beyond human endurance. In other situations[INVALID]Naval nuclear propulsion, space flight, combat outposts, long haul civilian aviation, continuous industrial processes, etc.[INVALID]the handoff problem is well managed. Though risks are high, calamities are rare. The fundamental problem is that healthcare providers (particularly those most senior) continue to view training and treatment solely as expression of individual professional skill rather than recognizing the coordinating routines necessary for success. By the same logic, we would have no ballet or symphonies, only soloists, no relay racers, only individualists, and basketball would look like playground pickup. Steve Spear Sr. Fellow, Institute for Healthcare Improvement Sr. Lecturer MIT

Edward Framer, Ph.D. (3/27/2013 at 6:06 PM)
And there are a lot of us out here who have seen unreasonably long shifts also cause unnecessary injury and death. There is no excuse for 100-120 hour work weeks or for sloppy handoffs.




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