Teaching hospitals would have to pay a total of $1.6 billion a year in additional labor costs if recent Institute of Medicine recommendations for limiting resident work hours are implemented, according to a report by the RAND Corp. and University of California at Los Angeles researchers in the May 21 edition of the New England Journal of Medicine. Last December, the IOM issued a report that included recommendations to retain the current 80-hour work limit, to limit work shifts to 16-consecutive hours, to require five hours of sleep for residents working extended shifts, and to give residents one day off a week and five days off a month. At the time, the cost was estimated at $1.7 billion. The NEJM report notes that the $1.6 billion figure it cites is in 2006 dollars, and could actually range from $1.1 billion to $2.5 billion depending on who supplies the substitute labor. The cost to individual hospitals ranges from $990,000 to $3.5 million. The study notes that there could be savings from averting fatigue-related adverse events and subsequent malpractice claims, but these latter effects on hospital profitability appear to be modest and unpredictable. An accompanying editorial argues against rapid implementation of the IOM recommendations and called for more study on their impact on preventable adverse events, patient handoffs, and their impact on residents preparedness for independent clinical practice. The Accreditation Council for Graduate Medical Education, the agency that monitors adherence to the 80-hour work limit, is convening a duty hour congress June 11-12, and the ACGME Duty Hours Task Force will prepare a proposal to current work hour rules to be presented to the ACGME board of directors in February 2010.Submit a letter to the Modern Physician Reader Blog. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.
Resident work-hour limits would cost teaching hospitals big
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