In a trial last spring, Mayo Clinic researchers cut 12 hours from residents' workweek, including swapping schedules that had a 30-hour shift for schedules with 14-hour shifts staggered round-the-clock.
The scheduling switch is one of many playing out in U.S. hospitals as residency programs look to balance the risk of overtired doctors against the potential harm of poor communication as shifts turn over.
The results of Mayo's experiment, published in the Dec. 6 edition of the journal Chest, adds to a growing but incomplete body of research on how best to train tomorrow's doctors and safely staff hospitals. Mayo's authors cautioned the small-scale study was "limited by inadequate sample size," but noted nonetheless that they found no statistical difference in patients' hospital stays, mortality or residents' education among the 626 patients and 34 internal medicine residents who participated.
The survey compared data collected during a five-week trial of 14-hour workdays at the Rochester, Minn., hospital during late March and April against a typical long-call schedule. The switch shortened residents' average workweek to 61 hours from 73 hours by scheduling 14-hour shifts to start in the morning and evening, said Rolf Hubmayr, a Mayo Clinic College of Medicine professor who oversees pulmonary and critical-care residents and fellows. On a long-call schedule, residents begin every shift at the same time each morning, but the lengths of shifts vary. Mayo's long-call allowed one full day off during a workweek but required doctors to be on call during one 30-hour in-house shift every four days.
Pressure to do away with marathon shifts led to new safety standards by the Accreditation Council for Graduate Medical Education in mid-2003. But hospitals must balance risks from fatigued physicians against the benefits of continuous care, Hubmayr said. Mayo's five-week test highlighted the need for clear, consistent communication between doctors' shifts, he said. "No single provider will know everything that every patient needs at any place, at any time," he said.
Previous studies have found shorter workdays reduce medical errors, though they may also contribute to adverse events as patients are transferred between doctors more frequently, the authors said.