Study: Shorter Residency Shifts Did Not Improve Care, Part 2

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Last week, two studies released the results of an analysis of the impact of a 16-hour limit on residency shifts. This limit reduced the amount of time that doctors-in-training can work from 30 hours. Although observers and experts hoped that this step help improve patient safety by giving residents enough time to rest, the opposite appears to be happening.

The interns who participated in the study reported that they were still not getting enough rest. More than 23 percent of participants said that they were “significantly more worried” that they were committing serious medical errors. The authors also described “an unanticipated increase in self-reported medical errors.”

One of the reasons for this big increase is likely the need for more frequent handoffs to new shifts. When residents or physicians work extremely long shifts, they do not need to pass patient care to an incoming doctor or group of nurses. Handoffs are a potentially dangerous process-it is all too easy for important details to get lost in the process.

When interns shifted from working 30 hours at a time to only 16 hours, the necessary result is that they have to pass patients to new shifts almost twice as frequently. This creates many more opportunities for error.

The implications of these results may be that the 16-hour shift is still too long. While even shorter shifts would require more handoffs, hospitals need to tackle that problem independently by taking advantage of existing best practices for communication. Residents with enough rest and sleep will be more equipped to effectively put these procedures into effective practice.

Source: ABC News, “For Resident Doctors, Shorter Shifts Mean More Mistakes,” Kathleen Struck, Mar. 26, 2013

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