Archive for: Duty Hours and Fatigue
ACGME gives update on duty hour reform
Since the IOM released the report on resident work hours last December, the ACGME has been working hard to address the concerns the IOM raised. After nearly a year of information gathering, ACGME CEO Thomas Nasca, MD released a letter to the GME community giving an update of their efforts.
Boston surgery program receives duty hour citation
The surgery residency program at Massachusetts General Hospital (MGH) in Boston received a citation from the ACGME for violating the duty hour standards, according to an article in the Boston Globe.
AAMC sends ACGME response to IOM duty hour recommendations
The Association of American Medical Colleges (AAMC) is the latest organization to send the ACGME a letter responding to the Institute of Medicine’s (IOM) duty hour recommendations.
The AAMC said it does not believe that duty hours and schedules are the biggest problem, according to a Apr. 21 letter to ACGME. Instead, the AAMC said efforts should focus more on identifying and managing fatigue, resident supervision, trainee workload, and handoffs.
The AAMC’s letter also outlines its positions regarding the following:
- Support of the 80-hour rule, but the AAMC says that scheduling should recognize the needs of patient care delivery and education of various specialties.
- Moonlighting activities should count toward the 80-hour limit or prohibited all together.
- The ACGME should maintain responsibility to monitor and enforce duty hour rules.
- ACGME review committees should examine and determine appropriate workloads for residents.
- ACGME review committees should establish new, enhanced supervision guidelines. The AAMC said supervision rules may include specific guidelines for when residents should consult with attending physicians or senior residents, or a requirement for the supervising physician to contact and check in with residents, rather than waiting to be contacted by trainees.
- Institutions should develop specific handoff policies that meet the needs of the institutions and various specialties.
ACGME seeking proposals for duty hour literature review
The ACGME took another step forward in its duty hour review/reform process today with a letter from the organization’s CEO, Thomas Nasca, MD, MACP, requesting proposals for A Comprehensive Literature Review and Analysis of Residency Training and Duty Hours Experience.
Individuals interested in performing the review are encouraged to submit a proposal describing their plans and procedures by May 22, and the final report is due by the end of August. The final report will be the ACGME Duty Hours Task Force as they make their decisions regarding new resident work hours, the letter said.
The ACGME asks applicants to review national and international literature of peer reviewed articles regarding:
- Resident duty hours
- Supervision
- Working conditions
- Sleep needs, patterns, and deprivation
- Fatigue
- Well-being
- Education
- Learning environment
- Moonlighting
- Medical errors
- Effects of the 2003 resident duty hour standards
- Other studies about resident training in teaching and non teaching settings
The ACGME will inform any and all accepted proposals by May 27,2009.
American Hospital Association releases opinions on duty hour reform
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.
Open Mic: What are you doing with the IOM duty hour recommendations?
As you may have read in my previous post on duty hours, the ACGME says they’re approaching duty hour reform with open ears. They want to hear from programs who are conducting pilot tests or performing cost analysis to determine whether implementing the recommendations is feasible.
At the 2009 ACGME Educational Conference, a program director described the pilot test underway in his program. It had only been a week, but the results already gave a picture as to how schedules needed to be arranged and the cost associated with implementing recommendations.
Another program director explained that it took his program five years to perfect a scheduling system to meet 2003 requirements. They started their planning in 1998.
I’m assuming many of you are taking a look at how possible changes to duty hour standards will impact your program. I would like to open the blog up to you, readers. . . Are there plans at your institution, at the program or institutional-level, to test some of the recommendations? If you’re not testing them, are you performing any cost analysis or looking at any other data? Share in the comment box below.
Live blog from ACGME Conference #4: Duty hours implementation
Just a quick post before I dash to the airport to catch my flight back home. . .
The earliest the ACGME will implement new duty hour rules is July 1, 2011, said Thomas Nasca, MD, MACP, during his presentation The Recommendations of the IOM Consensus Committee to Optimize Resident Hours and Work Schedules to Improve Patient Safety: Summary and Discussion at the 2009 ACGME Educational Conference.
However, depending on how greatly the new standards differ from the current ones, the ACGME could push that date back, Nasca added.
Either way, Nasca assured attendees that they will have plenty of notification to implement new rules prior to the effective date.
After attending all but one duty-hour related session at the conference, I have to tell you that I am impressed with how the ACGME is handling the scrutiny of the public and is rising to the challenge of reviewing current requirements.
I am also heartened to hear Nasca repeat several times that he wants the GME community’s input as the ACGME considers data and new reforms.
Whether you attended the conference or not, what do you think about the ACGME’s response to re-examining duty hours? As a program director or coordinator, what are your concerns if duty hour standards are reformed?
Remembering the patient whose case triggered duty hour reform
This week marks the anniversary of the death of Libby Zion. Even if you don’t know who Libby Zion is, you’ve definitely seen the effects of her passing-her case thrust the issues of resident supervision and long resident work hours into the national spotlight.
Zion went to the emergency room in 1984 with a high fever and irregular jerking movements, and she later died. After an investigation, her family discovered she was treated by residents who had been up for hours and had an overwhelming amount of patients to care for. The family launched a public crusade to make sure these issues were addressed.
Although it took nearly a decade for the ACGME to implement duty hour standards, Zion’s case is widely accepted as the impetus for the reform.
In the New York Times this week, columnist Pauline Chen wrote two articles I definitely recommend reading:
- On Young Doctors and Long Work Days, which includes a Q&A with ACGME CEO Thomas J. Nasca, MD about duty hour concerns and the future of reform after the recent IOM report
- A Life Changing Case for Doctors in Training, which takes a look at the Zion case and how far regulations have come since her death.
Also, check out the comments related to the first article. They offer really interesting insights from residents, patients, and physicians.
What do you think about where duty hour reform is headed? Do you agree with Nasca’s comments?
ACGME reveals plans for reviewing duty hour standards
The ACGME hasn’t said much since the Institute of Medicine release its duty hours recommendations back at the beginning of December. . . until now.
Today, this letter from ACGME CEO Thomas Nasca appeared on the accreditor’s Web site describing the actions the organization will take to review duty hour rules.
I’m still reading through and digesting the information, but look for a summary in Tuesday’s edition of our free e-newsletter, Residency Program Connection.
All I know is that I look forward to attending the session on duty hours at the ACGME conference in a few weeks!
Thomas Nasca, MD writes editorial on IOM report in USA Today
As debate over the Institute of Medicine’s report on resident work hours continues to swirl, ACGME CEO, Thomas Nasca, MD, expressed his views in an editorial published in USA Today.
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