First-year medical residents committed far fewer medical errors when their work shifts were limited to 16 hours rather than the traditional shifts of 24 hours or longer, according to a new study published in today's edition of the New England Journal of Medicine. The study is one of two reports in today's Journal showing that reduced hours for doctors-in-training lead to fewer errors and less "attentional failures," including nodding off while on duty.
The first study found that interns on a traditional shift at Brigham and Women's Hospital, Boston, made 36% more serious medical errors, including 5.6 times as many serious diagnostic mistakes, than colleagues working a 16-hour shift. The rate of serious medication error was 21% higher when the interns were working the longer shifts, according to the study, which officials called the most comprehensive of its kind on the impact of the lack of sleep on hospital care.
Both studies, officials said, suggest that limiting residents shifts to 16 hours could significantly improve patient safety.
"The impact of sleep deprivation on performance has been well-documented in other industries, but studies like these are providing evidence of its impact in healthcare," said Carolyn Clancy, the director of the Agency for Healthcare Research and Quality, which co-funded the studies.
The second study at Brigham and Women's, which surveyed the impact of reduced work hours on residents' sleep patterns, indicates that the rate of "attentional failures" was twice as high at night for residents who worked the longer, traditional schedules of up to 30 hours. It concluded that residents working shorter shifts were less sleep-deprived at work and were able to sleep longer at home.
Extended hours for residents have become a national issue in recent years. Last June, the Accreditation Council for Graduate Medical Education mandated that residents work no more than 88 hours a week, averaged over four weeks, with shifts limited to 30 hours. Some residents, especially those in specialties like surgery, were routinely working 120 hours a week or more before the ACGME made a change based at least in part on the fierce lobbying from groups like the American Medical Student Association and Public Citizen.
"These findings support AMSA's claim that patient safety is at the center of the resident work-hour debate," said Brian Palmer, M.D., the group's president.