Featured Research

from universities, journals, and other organizations

Reducing work hours for medical interns increases patient 'handoff' risks

Date:
March 25, 2013
Source:
Johns Hopkins Medicine
Summary:
Limiting the number of continuous hours worked by medical trainees failed to increase the amount of sleep each intern got per week, but dramatically increased the number of potentially dangerous handoffs of patients from one trainee to another, new research suggests. The reductions in work hours also decreased training time, the researchers found.

Limiting the number of continuous hours worked by medical trainees failed to increase the amount of sleep each intern got per week, but dramatically increased the number of potentially dangerous handoffs of patients from one trainee to another, new research from Johns Hopkins suggests. The reductions in work hours also decreased training time, the researchers found.

In 2011, stricter national regulations, reducing the continuous-duty hours of first-year resident physicians from 30 to 16, were put in place with the theory that limiting trainees' work hours would lead them to sleep more and that less fatigue would translate to fewer serious medical errors. But Sanjay V. Desai, M.D., leader of the new research described online in JAMA Internal Medicine, says data from his work do not support that idea. Instead, he says, his research suggests that unintended consequences of the new rules could be making patients less safe and compromising resident training.

"The consequences of these sweeping regulations are potentially very serious," says Desai, an assistant professor of medicine at the Johns Hopkins University School of Medicine, and director of the internal medicine residency program at The Johns Hopkins Hospital. "Despite the best of intentions, the reduced work hours are handcuffing training programs, and benefits to patient safety and trainee well-being have not been systematically demonstrated."

He says the 16-hour limit was put in place without evidence of whether it would improve patient safety and outcomes. "We need a rigorous study," Desai says. "We need data to inform this critical issue." Now is the time to collect it, he says.

For the study just reported, Desai and his Johns Hopkins colleagues compared three different work schedules in the months leading up to the 2011 change. For three months, groups of medical interns were assigned randomly to either a 2003-compliant model of being on call every fourth night, with a 30-hour duty limit, or to one of two 2011-compliant models. The latter included being on call every fifth night but working only 16 hours straight, or a night float schedule, which essentially had interns working a regular week on the night shift not exceeding 16 hours.

Although interns on the 16-hour limit schedule did sleep an average of three hours longer during the 48 hours encompassing their on-call period than those working 30-hour shifts, there was no difference in the amount of sleep they got across a week. "During each call period, the interns had 14 extra hours out of the hospital, but they only used three of those hours for sleeping," Desai says. "We don't know if that's enough of a physiologically meaningful increase in sleep to improve patient safety."

In the study, the researchers found, the minimal number of patient handoffs between interns increased from three for those working 30 hours to as high as nine for those working 16-hour shifts. The more handoffs, the less continuity of care and the more room for medication and other treatment and communication errors, past research has shown. Meanwhile, the minimal number of different interns caring for a given patient during a three-day stay increased from three to as high as five. Whether or not, or in what way, that affects patient care or patient satisfaction is another unknown, Desai says.

Trainees and nurses alike said they perceived higher quality of care on the 30-hour model, the study found. In fact, Desai says, the perception of quality of care was reduced so much in the night float model that it was stopped early.

Desai says their study showed that educational opportunities suffer greatly from the 16-hour restrictions. A main component of an intern's education at Johns Hopkins is rounds, which used to occur for three to four hours each morning as senior physicians led trainees from bedside to bedside, quizzing them and offering instruction for how to care for each patient. Rounding time has been cut in half to accommodate the shrinking schedules of interns, even though rounds are at the core of patient care and trainee education.

Before the limits, interns did all patient admissions and generally spent the next 24 hours following those they admitted through the course of their disease. Now, there are times in the day when interns cannot admit the patients and cannot see them through initial assessments.

Ideally, Desai says, the ACGME rules can be relaxed if there is evidence they are not achieving their goals. The current rigidity stifles innovation, he adds.

"Dramatic policy changes, such as the move to 16 hours, without a better understanding of their implications are concerning," he says. "Training for the next generation of physicians is at risk."

Other Johns Hopkins researchers involved in the research include Leonard Feldman, M.D.; Lorrel Brown, M.D.; Rebecca Dezube, M.D.; Hsin-Chieh "Jessica" Yeh, Ph.D.; Naresh Punjabi, M.D., Ph.D.; Kia Afshar, M.D.; Michael R. Grunwald, M.D., Ph.D.; Colleen Harrington, M.D.; Rakhi Naik, M.D.; and Joseph Cofrancesco Jr., M.D., M.P.H.


Story Source:

The above story is based on materials provided by Johns Hopkins Medicine. Note: Materials may be edited for content and length.


Journal Reference:

  1. Desai SV, Feldman L, Brown L, et al. Effect of the 2011 vs 2003 Duty Hour Regulation–Compliant Models on Sleep Duration, Trainee Education, and Continuity of Patient Care Among Internal Medicine House Staff: A Randomized Trial. JAMA Internal Medicine, 2013; DOI: 10.1001/jamainternmed.2013.2973

Cite This Page:

Johns Hopkins Medicine. "Reducing work hours for medical interns increases patient 'handoff' risks." ScienceDaily. ScienceDaily, 25 March 2013. <www.sciencedaily.com/releases/2013/03/130325183819.htm>.
Johns Hopkins Medicine. (2013, March 25). Reducing work hours for medical interns increases patient 'handoff' risks. ScienceDaily. Retrieved August 20, 2014 from www.sciencedaily.com/releases/2013/03/130325183819.htm
Johns Hopkins Medicine. "Reducing work hours for medical interns increases patient 'handoff' risks." ScienceDaily. www.sciencedaily.com/releases/2013/03/130325183819.htm (accessed August 20, 2014).

Share This




More Health & Medicine News

Wednesday, August 20, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Possible Ebola Patient in Isolation at California Hospital

Possible Ebola Patient in Isolation at California Hospital

Reuters - US Online Video (Aug. 20, 2014) A patient who may have been exposed to the Ebola virus is in isolation at the Kaiser Permanente South Sacramento Medical Center. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
Raw: World's Oldest Man Lives in Japan

Raw: World's Oldest Man Lives in Japan

AP (Aug. 20, 2014) A 111-year-old Japanese was certified as the world's oldest man by Guinness World Records on Wednesday. Sakari Momoi, a native of Fukushima in northern Japan, was given a certificate at a hospital in Tokyo. (Aug. 20) Video provided by AP
Powered by NewsLook.com
Do More Wedding Guests Make A Happier Marriage?

Do More Wedding Guests Make A Happier Marriage?

Newsy (Aug. 20, 2014) A new study found couples who had at least 150 guests at their weddings were more likely to report being happy in their marriages. Video provided by Newsy
Powered by NewsLook.com
Ebola-Hit Sierra Leone's Freetown a City on Edge

Ebola-Hit Sierra Leone's Freetown a City on Edge

AFP (Aug. 19, 2014) Residents of Sierra Leone's capital voice their fears as the Ebola virus sweeps through west Africa. Duration: 00:56 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins