Archive for: Duty Hours and Fatigue
Monday’s Poll: Institute of Medicine Resident Work Hour Report
Last week, I wrote about the IOM’s recommended changes to resident work hours. The IOM report is sparking a lot of heated debate around the issue of fatigue, duty hours, and resident training.
Institute of Medicine recommends major changes to duty hours
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.
Duty hours violations puts program’s accreditation in jeopardy
On Sunday, the Boston Globe reported that the surgery program at Beth Israel Deaconess Medical Center (BIDMC) may lose its accreditation due to duty hour violations.
According to the Globe, after a review in July, the ACGME cited the program for not meeting the standards. During its review of the program, the council identified regular instances of residents working seven days straight and 90 hour weeks, the article reports.
BIDMC administration had until yesterday to fix the problems when the ACGME visited the program to check on their progress.
In the article, the head of the surgery residency program discusses what they’ve done to prevent violations. He also points out that if a resident is at the limit, and a patient walks in with an aneurysm, the resident “doesn’t have the luxury of saying ‘I’m sorry, I have to go home.’”
How does your program handle instances like the supervisor of the surgery program describes? What do you do when a resident is up against their limit, and a patient rolls in with a life-threatening injury?
Intern insights
Although many interns are starting to lose their deer-in-the-headlights look, this interview with an intern from Wall Street Journal Health Blog is worth checking out.
Reading this interview gave me a greater understanding of what’s going through an intern’s head as he or she walks through the doors on day one. I think it’s really cool this emergency medicine resident feels comfortable talking about how he made mistakes, doubted his own skills, and felt overwhelmed during his first week. I’m glad to hear he’s developed a few strategies for clearing his head too. I think that’s important to develop early on because the training only gets harder.
I’m curious. . . how do the residents in your program blow off steam?
The effect of duty hours
Work hour limitations for residents have come under a lot of scrutiny lately. USA Today reports on a new study in Pediatrics that shows the regulations have had little impact on how much sleep residents get, how many hours they work, and the number of mistakes they make.
According to USA Today, the ACGME says the study may not have the current data about work hours.
The comments readers left in response to the USA Today article are pretty interesting. Many physicians, nurses, and residents writing in to describe their own experiences. Definitely worth a read.
What are your thoughts on duty hours? Do you think they increase patient and resident safety, or not?
Sleepy resident
For those of you who don’t know, I live right in the middle of Boston. Last week, I was on the T—Boston’s subway system— and I noticed a young man falling asleep in his seat right in the middle of this crowded, noisy, jostling train.
I felt bad for the poor guy and started to look away, but before I turned my head, I saw he was wearing hospital scrubs. Although there’s no way for me to know for sure, I guessed this sleepy traveler was a resident feeling the effects of fatigue.
Seeing this really hit home for me and underscored the importance of duty hour limitations, and educating residents on what to do if they’re feeling fatigued. As I watched him—eyes closed, head continuously nodding off— I couldn’t help but put myself in the place of the last patient he saw that day.
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