A new nationwide poll finds that “the vast majority of the American public” favors a restriction on medical residents’ work hours and opposes proposals to lift the 16-hour limit currently imposed on first-year residents.
More important for hospital owners and administrators, the poll results indicate that Americans understand the issue of medical residents’ long work hours and that the resulting fatigue is a major contributor to avoidable medical errors that harm patients.
Current resident work-hour rules set by the Accreditation Council for Graduate Medical Education (ACGME) allow medical residents to work up to 80 hours a week, with a maximum of 30 hours straight in a single shift and at least 10 hours off between shifts.
First-year residents, known as “interns,” may work a maximum of 16 duty hours in a single shift, according to ACGME standards.
The poll, commissioned by Public Citizen, shows that most Americans favor restricting the work shifts of all medical residents (also known as “resident physicians”), according to a Public Citizen news release.
Lake Research Partners, an independent public opinion research firm, conducted the survey, which was published in September.
The ACGME’s current rules were adopted in 2011 based on the conclusions of a 16-member task force that worked for two years.
The organization reviews its policies every five years, and the ACGME Board of Directors established a task force in September 2015 to develop recommendations for revising duty-hour restrictions. The task force is expected to release a proposal for public comment “in the coming months.”
Dozens of physicians’ groups are pushing the ACGME to allow first-year medical residents to work 28 or more hours in a row without sleep, Public Citizen says.
“A substantial body of literature shows that sleep deprivation due to excessively long work shifts increases residents’ risk of motor vehicle accidents, depression, and needle-stick and other injuries that can expose residents to bloodborne pathogens,” the report accompanying poll results says.
“Depriving medical residents of sleep for more than 16 hours also impairs performance and exposes their patients to an increased risk of medical errors, which can lead to patient injury and death.”
According to the environment, health and safety journal, EHS Today, doctors who work shifts longer than 20 hours have a 73 percent higher risk of piercing themselves with medical instruments and a 178 percent increased risk of getting into a motor vehicle accident while driving home.
Physicians who work longer shifts also show an increased risk of cardiovascular disease, blood pressure and cancer.
Dr. Charles Czeisler, Ph.D., Baldino Professor of Sleep Medicine, Harvard Medical School, told EHS Today that performance is likely to be “severely impaired” if students works longer than a 24-hour shift.
“Performance is equivalent to being drunk when working shifts longer than 24 hours, or extended-duration shifts,” Czeisler said. “The risk of a serious medical error is up by more than 300 percent when working extended-duration shifts.”
“Medical residents are not superhuman, and when they’re not getting sleep, they’re putting patients in harm’s way,” Dr. Michael Carome, director of Public Citizen’s Health Research Group, said. “This is not a partisan political issue, but one of public health and safety.”
Indeed, the Public Citizen survey, which was conducted in 10-minute telephone conversations during July of this election year, found bipartisan results.
Of the 86 percent of respondents who opposed the proposal to eliminate the current 16-hour shift limit for first-year residents, “opposition holds across party lines — with 84 percent of Democrats, 83 percent of independents, and 88 percent of Republicans in opposition,” the report says.
The report’s authors acknowledge that one of the primary arguments against reducing residents’ work shifts is that this would increase the number of handoffs necessary to transition patient care from one resident to another, and thus, it would interfere with the continuity of care.
However, they say, handoffs cannot be eliminated and, according to numerous recent studies, they can be done in a manner that minimizes errors.
“Furthermore, all else being equal, a resident handing off a patient after a 16-hour shift will undoubtedly be more alert than will a sleep-deprived resident at the end of a 28-hour or longer shift,” the report says.
“This new poll makes clear that the American public’s opinion on resident duty hours has not changed since a similar poll was conducted in 2009-2010,” the conclusion to the report says.
The prior survey found that 90 percent of the public favored restricting all medical resident work shifts to no more than 16 straight hours without sleep.
“The public is overwhelmingly opposed to lifting the 16-hour maximum shift length for interns, and favors, by similar margins, the implementation of a new similar cap for all other medical residents,” the study authors continue. “The public strongly feels that patients should be informed if the doctor treating them has worked for more than 16 hours in a row.
“The ACGME acted counter to public opinion when it allowed second-year-and-above residents to work 28 hours consecutively without sleep in its 2011 rules, and it risks continuing to do so should it disregard the latest poll’s results.”
In addition to acting counter to public opinion, continuing to allow medical residents to work extended-duration shifts is counter to public safety.
To quote further from the survey report, “The science is clear: residents, like any other human beings, are unable to avoid the cognitive and motor limitations that inevitably accompany prolonged sleeplessness, and both residents and their patients are put at risk once residents’ shifts exceed the 16-hour mark.”
Medical errors that occur due to sleep deprivation are avoidable, if only hospitals would adopt proper duty-hour restrictions.
The basis of a medical malpractice lawsuit is the injured party’s ability to demonstrate that a medical error that caused harm was avoidable if the physician and/or the physician’s supervisors had proceeded with an appropriate standard of care.
If you believe you or a loved one was harmed by a medical professional who was sleep-deprived, contact Salvi, Schostok & Pritchard P.C. in Chicago for a free review of your legal options.