Long hours cause of medical errors among residents

More than 80% of first-year medical residents work more hours than allowed by national accreditation rules, according to two studies published on Wednesday in the Journal of the American Medical Association, the Washington Post reports (Washington Post, 9/6).

Under rules established by the Accreditation Council for Graduate Medical Education, residents can work no more than 80 hours per week. In addition, residents must have at least 10 hours of rest between shifts and cannot work more than 24 hours at a time (Kaiser Daily Health Policy Report, 10/28/04). For one study, Christopher Landrigan of Brigham and Women's Hospital and colleagues surveyed 4,000 residents online from July 2003 through May 2004. According to the study, 84% of first-year residents violated the rules at some point. The study also finds that residents at nine in 10 hospitals violated the rules at some point (Kowalczyk, Boston Globe, 9/6). For a second study, Nijib Ayas of Harvard Medical School and colleagues surveyed 2,737 first-year residents online to determine the effects of a longer workday on their performance. Respondents who worked 20 consecutive hours had a 61% higher risk for self-injury through needle or scalpel sticks than those who worked 12 consecutive hours, the study finds. According to the study, 498 respondents reported self-injuries during a one-year period (Talan, Long Island Newsday, 9/6).

Medical Errors

In related news, a third study published in JAMA finds that internal medicine residents often commit medical errors that lead to depression, burnout and less empathy for patients, the Washington Times reports. For the study, Tait Shanafelt of the Mayo Clinic and colleagues analyzed data on 84% of eligible internal medicine residents at the hospital between 2003 and 2006. About 15% of participants reported that they had committed a medical error in the previous three months, and 34% reported that they had committed at least one major error over a one- to three-year period, the study finds. According to the study, participants who reported that they had committed medical errors were three times more likely to test positive for depression than those who had not committed errors. In addition, the study finds that participants with symptoms of depression and burnout were more likely to commit medical errors in the subsequent three months. The study recommends that residency programs attempt "to prevent, identify, and treat burnout and to promote empathy and well-being for the welfare of (both) residents and patients" (Howard Price, Washington Times, 9/6). Shanafelt said, "There may be problems with the system. Work-hour limitations are a step in the right direction. But there still may be more to do" (Ritter, Chicago Sun Times, 9/6).

An abstract of the Landrigan study is available online, and an abstract of the Shanafelt study also is available online. In addition, the Ayas study is available online. An extract of a related JAMA commentary published in is available online, and an extract of a related JAMA editorial also is available online.

Broadcast Coverage

NPR's "All Things Considered" on Tuesday reported on the studies. The segment includes comments from Charles Czeisler, a professor of sleep medicine in the Division of Medical Sciences at Harvard University; Landrigan; David Leach, executive director of ACGME; and Troy Madsen, an emergency department resident who had to transfer to different hospital after a violation of rules on work hours (Rovner, "All Things Considered," NPR, 9/5). The complete segment is available online in RealPlayer.