American Hospital Association releases opinions on duty hour reform

By: Julie McCoy April 21st, 2009

The American Hospital Association (AHA) released a letter outlining its opinions of the IOM duty hours report and made a few recommendations yesterday.

The letter-addressed to ACGME CEO Thomas Nasca-commends the organization for reviewing the duty hour standards, but points out that duty hours are not end-all-be-all of measuring fatigue.

“…We use duty hours as an implied proxy for measuring sleep and alertness,” according to the April 20 AHA statement. “This is, at best, an inadequate proxy because the hospital and residency program director have no information on what the resident actually did during the hours not on duty.”

Additionally, the AHA says a full cache of research on the effects of duty hours on training does not exist as some 6-7 year-long programs have yet to graduate a full class of residents trained under the five year old standards. The AHA also points out that not enough sleep research has been conducted looking specifically at physicians-in-training.

“The generic sleep literature suggests that mental alertness and task performance decline after about 16 hours of time or after four consecutive night shifts for most persons. However, it is unclear if these general findings are applicable to physicians-in-training who are young and intellectually engaged in their activities,” the AHA statement says.

The AHA does say that the 80 hour/week rule, standards for no more than every third night for in-hospital call, and the one day off per week rule should be changed.

To see the rest of the AHA’s recommendations, take a look at this crosswalk comparing the ACGME’s current standards, the IOM’s recommendations, and the AHA position.

What do you think of the AHA’s statement? Leave a comment in the box below.

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