Institute of Medicine recommends major changes to duty hours

By: Julie McCoy December 3rd, 2008

An Institute of Medicine (IOM) report, released yesterday, calls for several changes to duty hour regulations. The report, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, advocates for protected sleep time for residents, more supervision of residents, and more effective hand off processes, which the organization estimates could cost as much as $1.7 billion to implement. To read about the proposed recommendations check out the Report Brief and Table of Recommendations. In response to the report, the ACGME released a statement saying that they appreciate the IOM’s report, and they will consider the suggestions during a duty hours conference in March 2009. There has also been a ton of chatter on various Web sites regarding the recommended changes. Check out some of the following links:

Consumer advocacy group Public Citizen says the IOM’s recommendations do not go far enough to protect patients and faults the IOM for not increasing The Joint Commission or CMS more oversight responsibility.
The American Academy of Sleep Medicine says they will thoroughly review the IOM’s report, will continue giving the ACGME advice on resident fatigue, and will support duty hour regulations that promote patient safety.
American Association of Neurological Surgeons and Congress of Neurological Surgeons released a statement saying they have several concerns about the IOM’s recommendations, including patient safety concerns associated with too many patient hand offs and a lack of continuity of care. The group is also concerned that further limitations may not provide residents with the experiences they need to adequately care for complex patient cases.
Agency for Healthcare Research and Quality (AHRQ), who funded the study, commends the IOM’s report
AMA congratulates the IOM on their efforts to help residents and patients. The group says they continue to support the 80-hour per week duty hour limits.

What are your thoughts on the proposed changes? How do you think they’ll change the way program directors and coordinators monitor duty hours?