Re: Many Surgical Residents Say Current Duty Hour Restrictions Put Safety At Risk
From: art fougner, md (evsono@pipeline.com)
Fri Jul 17 08:37:09 2009
No good deed goes unpunished.
Art
At Fri, 17 Jul 2009, GIN11153@aol.com wrote:
>
>Heather Comak, for HealthLeaders Media, July 15, 2009
>A significant portion of surgical residents think the hours imposed on
>their work schedules inhibit their surgical education and puts patients' safety
>at risk, according to a study published in the July _Journal of the
>American College of Surgeons_
>(http://www.journalacs.org/article/S1072-7515(09)00223-3/abstract) . Although not a majority, 41% of surgical residents
>included in the study felt that the duty hour regulations implemented by the
>Accreditation Council for Graduate Medical Education (ACGME) presented a
>"moderate barrier" to their surgical education.
>The duty hour regulations were originally put in place by the ACGME in 2003
> in an effort to prevent surgical errors, keep patients safer, and give
>residents more time on their own by acknowledging that overtired residents are
>more prone to make mistakes. Currently surgical residents are required to
>work no more than 80 hours in a week, and have no less than 10 hours
>between shifts. The _Institute of Medicine_
>(http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12508) is recommending that residents working
>any overnight shifts of 30 hours or longer be given time to nap and that
>residents work no longer than a 16 hour shift without sleep.
>Because of the ACGME hour restrictions, surgical residents do report
>getting more sleep and having more time for their personal lives. However, a
>significant of surgical residents percentage are reporting that they think
>patients' safety is being negatively affected by the hour restrictions due to
>increased patient handoffs and lack of continuity of care. Forty-three
>percent of respondents felt that the ideal work week would be between 80 and 100
>hours, while 52% thought that the 60-80 hours was adequate.
>"We were surprised to find that nearly half of surgical residents believe
>work-hour restrictions are actually an impediment to their training," said
>Jacob Moalem, MD, Department of Surgery, University of Rochester (NY)
>Medical Center, and lead author of the study. "Our current system limits
>educational opportunities for surgeons who are expressing a desire and a need to
>learn more in a compact timeframe. Senior surgery residents should be given
>the chance to control their own schedules as they continue to refine their
>technical skills and transition into independent practice."
>The study surveyed resident and associate members of the American College
>of Surgeons electronically, of which 599 responded. They were asked to rate
>if the duty hour regulations affected their surgical education, and also
>what the appropriate number of hours per week they think should be worked
>during their postgraduate year from the choices of less than 60, 60 to 80, 80
>to 100, or more than 100.
>Interestingly, residents who were closer to graduation were those who more
>strongly felt that the duty hour regulations interfered with their
>education as compared with residents in their first and second years. Seven percent
>of junior residents reported that the duty hour regulations did not impede
>on their education, while 32% of residents in or post their seventh
>postgraduate year said they felt the regulations interfered with their education.
>The researchers concluded that having a "one size fits all" rule for hours
>may not be the best practice. Instead, finding a schedule that works for
>individual residents may result in safer patients and better educated
>surgeons.
>Although the hour limitations were put in place to promote patient safety,
>there has been little evidence published to show that the reduction in
>hours actually does improve patient safety. Some hospitals are finding it
>difficult to balance the hour limitations while providing safe care for patients
>and adequately educating surgeons. However, surgical programs do strive
>for compliance and have focused more on promoting well rested residents since
> 2003.
>
>____________________________________
>
>____________________________________
>Heather Comak is a Managing Editor at _HCPro, Inc._ (http://www.hcpro.com/)
>____________________________________
>, where she is the editor of the monthly publication _Briefings on Patient
>____________________________________
> Safety_ (http://www.hcmarketplace.com/prod-234.html) , as well as patient
>safety-related books and audio conferences. She is also is the Assistant
>Director of the Association for Healthcare Accreditation Professionals.
>
>_http://www.healthleadersmedia.com/content/235994/topic/WS_HLM2_PHY/Many-Surgical-Residents-Say-Current-Duty-Hour-Restrictions-Put-Safety-At-Risk.htm_
>(http://www.healthleadersmedia.com/content/235994/topic/WS_HLM2_PHY/Many-Sur
>gical-Residents-Say-Current-Duty-Hour-Restrictions-Put-Safety-At-Risk.htm)
>
>slove00000001)
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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