The legacy of Dr. Jeff Levy and novelist Sidney Zion is evident in two studies on resident work hours in the Dec. 10 issue of JAMA.
The studies compare 30-day mortality and readmission rates before and after new restrictions on resident work hours were imposed by the Accreditation Council for Graduate Medical Education in 2011.
The debate over the 80-hour workweek limit (averaged over four weeks) often focuses on “patient handoffs” between residents. The concern is that vital information may be lost as one doctor in training passes the baton (or patient chart) to the next as one shift ends and the other begins. The findings of these studies suggest that steps taken to make these exchanges safer have helped.
Dr. Lucian Leape, patient-safety pioneer and Harvard School of Public Health adjunct professor of health policy, credits the efforts of the late journalist, prosecutor and novelist Sidney Zion for getting work limits implemented.
Zion seized on the issues of residents working without rest or supervision after his 18-year-old daughter died several hours after being admitted to New York Hospital on the night of March 4, 1984.
Zion and his wife, Elsa, stated their case for resident-training reform in a “60 Minutes” segment entitled “The 36-Hour Day” that aired Feb. 8, 1987.
As part of that episode, Dr. Jeff Levy, then a first-year resident at Mount Sinai Hospital in Manhattan, allowed reporter Mike Wallace to shadow him during a 36-hour shift. Levy managed to get in two naps totaling about three hours of sleep and Wallace made a point of highlighting Levy's fatigue two-thirds into his shift.
Soon afterward, the New York Health Commissioner appointed an advisory panel to study the issue of resident work hours, and it issued a 1987 recommendation to limit residents to 80-hour workweeks and 24-hour shifts. The state adopted these limits in 1989. The ACGME instituted its original nationwide 80-hour work week in July 2003.
Whether Levy feels his appearance on “60 Minutes” had an influence on the implementation of work-hour limits or if he feels he was taken advantage of by Wallace could not be determined. Attempts to reach him through Mount Sinai have been unsuccessful.
Internet searches uncovered several Dr. Jeff Levys, but none that appear to have trained at Mount Sinai in 1987.
The results of the new JAMA studies appear to be much like Levy's shift documented by “60 Minutes.” No patients appeared to be harmed, but it's still difficult to fathom that there aren't diminishing returns in quality of care for patients and training for residents after 20-plus hours on the job.
Follow Andis Robeznieks on Twitter: @MHARobeznieks
