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More Information on Medical Resident Work Hours

Letter Advocating Reduction of Resident Work Hours

February 4, 2010

Thomas J. Nasca, M.D.
Executive Director
Accreditation Council for Graduate Medical Education
515 State St. #2000
Chicago, IL 60654

cc. Rep. Henry A. Waxman, Chair, House Energy & Commerce Committee.

RE: Optimizing Medical Resident Schedules to Improve Patient Safety

Dear Dr. Nasca:

In December 2008, the Institute of Medicine (IOM) released its landmark report, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, the most comprehensive study of resident work hours conducted to date. The study reviews the robust evidence base linking fatigue with decreased performance in both research laboratory and clinical settings and makes a number of important recommendations for changes in the current system of training physicians. These include new limits on resident physician work hours and work load, increased supervision, training in structured hand-overs and quality improvement systems, more rigorous oversight  and the identification of expanded funding sources necessary to successfully implement the recommended reforms.

In response to the release of this report, we understand that the ACGME formed a Duty Hours Task Force and charged it with recommending revisions to the current duty hour and supervision standards. We are concerned, however, that the ACGME is not adequately weighing the concerns of patients in its deliberations.

Indeed, the available evidence suggests that the public is deeply concerned about the current work hours of medical residents. In a 2002 national public opinion poll conducted by the National Sleep Foundation, 70 percent of respondents reported that they were “somewhat likely” or “very likely” to request another doctor if  they learned that their doctor had been working for 24 hours consecutively. Additionally, in a 2004 Kaiser Family Foundation  public opinion poll, 74 percent of respondents listed “stress, overwork, or fatigue of health professionals” as a “very important  cause of medical errors” and 66 percent agreed that reducing the  work hours of doctors to avoid fatigue would be a “very effective” way to reduce medical errors.

We strongly urge the ACGME to make patient safety a central focus of its response to the IOM’s recommendations. There is no scientific evidence to support the idea that a responsibly implemented reduction in working hours as contemplated by the IOM will limit educational opportunities or otherwise leave residents less prepared to practice medicine. Rather, there is abundant evidence showing that the ability of human beings to learn and to perform tasks is compromised by fatigue. Resident physicians are not immune to these universal physiological responses. The IOM recommendations limiting resident hours and workload, training residents in effective techniques for transferring patient information and improving supervision will, we believe, improve  patient safety in the nation’s teaching hospitals.

Given press reports over the past year highlighting the academic medical community’s criticisms of the IOM recommendations as well  as information on the ACGME website (Open Letter to the GME Community from Thomas J. Nasca, M.D., MACP, 10/28/09), we are fearful that the ACGME will choose not to adequately act on the evidence at  this critical juncture.  It is our belief that the ACGME’s commitment to quality patient care and resident education should, at a minimum, result in prompt adoption of the IOM recommendations.

Sincerely,

Helen Haskell
Founder and President
Mothers Against Medical Error
155 South Bull Street
Columbia, South Carolina 29205
www.mamemomsonline.org

Sidney Wolfe, M.D.
Director
Alan Levine
Health Care Researcher
Public Citizen Health Research Group
1600 20th Street, NW
Washington, DC 20009
www.citizen.org

Ilene Corina
President
PULSE of NY
P.O. Box 353
Wantagh, NY 11793-0353
www.pulseofny.org

Arthur Aaron Levin M.P.H.
Director
Center for Medical Consumers
239 Thompson Street
New York, NY 10012
www.medicalconsumers.org 

Sorrel King
President and Co-Founder
The Josie King Foundation
Baltimore, MD
www.josieking.org 

David A. Swankin, Esq.
President and CEO
Citizen Advocacy Center (CAC)
1400 16th Street NW Suite 101
Washington, DC 20036
www.cacenter.org

Lisa McGiffert
Campaign Manager
Safe Patient Project
Consumers Union
506 West 14th Street, Suite A
Austin, TX 78701
www.safepatientproject.org

Julia Hallisy
President
The Empowered Patient Coalition
595 Buckingham Way, Suite 305
San Francisco, CA 94132
www.empoweredpatientcoalition.org

Ken Farbstein
President
Consumer Health Quality Council
Health Care for All Massachusetts
Cambridge, MA
www.hcfama.org

Dale Ann Micalizzi
Founder and Director
Justin's HOPE at
The Task Force For Global Health
136 Bogusky Ct.
Schenectady, NY 12306
www.taskforce.org/justinhope.asp 

Jean Rexford
Executive Director
CT Center for Patient Safety
26 West Woodland Drive
Redding CT 06896
www.ctcps.org

Susan Sheridan, MIM, M.B.A
President
Mitchell L. Dvorak, M.S., CAE
Executive Director
Consumers Advancing Patient Safety (CAPS)
405 N. Wabash Avenue, Suite P2W
Chicago, IL 60611
www.patientsafety.org 

Jeanine Thomas
Founder and President
MRSA Survivors Network
P.O. Box 241
Hinsdale, IL 60521
www.mrsasurvivors.org

Karen Dixon, Ph.D.
President
Parents of Infants and Children with Kernicterus (PICK)
405 N. Wabash, Ste. P2W
Chicago, IL 60611
www.pickonline.org

Lenore Janecek
Founder and President
Save The Patient
260 E. Chestnut, #1712
Chicago, IL 60611
www.savethepatient.org 

Blair Horner
Legislative Director
New York Public Interest Research Group
107 Washington Avenue
Albany NY, 12210
www.nypirg.org 

Ted Zimmer
Director
Consumer Health Coalition
650 Smithfield Street
Pittsburgh, PA 15222-3912
www.consumerhealthcoalition.org

Jennifer Dingman
Founder, PULSE of Colorado
Co-Founder, PULSE of America
Founder, Pulse of America Coalition for Healthcare Reform
5249 Manor Brier Ct.
Pueblo, CO 81005
www.pulseamerica.org 

Roberta Mikles, R.N. B.A.
Patient Safety Advocate
Advocates4QualitySafeCare
San Diego, CA
www.qualitysafepatientcare.com

Martin J. Hatlie, J.D.
President
Partnership for Patient Safety
405 N. Wabash P2W
Chicago, IL 60611
www.p4ps.org 

Trisha Torrey
Founder
DiagKNOWsis Family of Patient Services
P.O. Box 53
Baldwinsville, NY 13027
www.DiagKNOWsis.org

Regina Holliday
Muralist and Activist
Medical Advocacy Mural Project
Washington, DC
http://www.open-health.us/topics/reginas-advocacy-timeline 

Becky Martins
Founder
Voice4Patients.Com
P.O. Box 273
Warren, ME 04864
www.voice4patients.com 

Karen Aydt Curtiss
Founder
CampaignZERO
736 North Western Avenue, #326
Lake Forest, IL 60045
www.campaignzero.com

Lori Nerbonne, R.N., B.S.N.
Co-Founder
NH Patient Voices
6 Fieldstone Drive
Bow, NH 03304

Carol Weihrer
President & Founder
Anesthesia Awareness Campaign, Inc.
1658 Parkcrest Circle #200
Reston, VA 20190-4946
www.anesthesiaawareness.com 

Martine Ehrenclou, M.A.
Author, Critical Conditions: The Essential Hospital Guide To Get Your Loved One Out Alive
CriticalConditions.com
1158 26th Street, Suite #502
Santa Monica, CA 90403
www.criticalconditions.com

Patty Skolnik
Founder and Executive Director
Citizens for Patient Safety
801 Yosemite St.
Denver, CO 80230
www.citizensforpatientsafety.org

Kevin Kavanagh, M.D.
Health Watch USA
3396 Woodhaven Dr
Somerset, KY 42503
www.healthwatchusa.org

Kim Witczak
Woodymatters
345 North 6th Avenue, #102
Minneapolis, MN 55401
www.woodymatters.com

Jan S. Vick
Executive Director
SC Voices for Patient Safety
P.O. Box 776,
Chesterfield, SC 29709
www.scvps.org 

Pat Mastors
The Empowered Patient
East Greenwich, RI
www.infectiondefense.com

John T. James
Founder
Patient Safety America
14503 Windy Ridge Lane
Houston, TX 77062
www.patientsafetyamerica.com

Bart Windrum
President and Presenter
Axiom Action
Author, Notes from the Waiting Room: Managing a Loved One's End of Life Hospitalization
3855 Telluride Place
Boulder, CO 80305-7219
www.axiomaction.com

John C. Ruoff, Ph.D.
Program Director
South Carolina Fair Share
P.O. Box 8888
2001 Assembly St., Ste. 107
Columbia, SC 29202
www.scfairshare.org

Harvey S. Frey M.D. Ph.D. Esq.
Health Administration Responsibility Project
Santa Monica, CA
www.harp.org

Mary Ellen Mannix, MRPE
Founder and President
The STB Project 
618 Kirsch Ave
Wayne, PA 19087
www.splitthebaby.com

Patti O'Regan, DNP(c), ARNP, ANP, NP-C, PMHNP-BC
Board Certified Nurse Practitioner
Adult Primary Care & Psychiatry
Founder and Committee Chair,
World, Global, National Patient Safety Day
Tampa Bay Area, Florida
www.worldpatientsafetyday.com 

DK Raymer
Healthcare PSI
2733 E. Battlefield #272
Springfield, MO 65804
www.healthcarepsi.com

Bonnie Getz
President
Fight Staph Infections Inc.
624 Station West Lane
Roebuck, SC 29376
www.staphfight.com

Lisa Lindell
Author and Coordinator
108Days.com
Texas Coordinator, PULSE of America
P.O. Box 57491
Webster TX 77598
www.108days.com

Doug Hall
Principal
PULSE of Florida
Palm Harbor, FL
www.PULSEofFlorida.org 

Alicia Cole
HAI Survivor and Founder
Alliance for Safety Awareness for Patients
14622 Ventura Blvd., #102-827
Sherman Oaks, CA 91413
www.PatientSafetyASAP.org

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