Oct. 27, 2004
Statement of Peter Lurie, MD, MPH, Deputy Director of Public Citizen’s Health Research Group, on Two Studies in New England Journal of Medicine Showing Benefits of Reduced Hours for Doctors in Training
Two landmark studies published in today’s New England Journal of Medicine confirm what common sense and previous research have suggested: Reducing the number of hours worked by residents will lead to better-rested residents who make significantly fewer serious medical errors.
In 2001, Public Citizen, the American Medical Student Association (AMSA) and the Committee on Interns and Residents filed a petition with the Occupational Safety and Health Administration (OSHA), and AMSA and Public Citizen helped with legislation introduced in both houses of Congress requiring a reduction in work hours to under 80 each week, with a short period for hand-over between shifts, with shifts not to exceed 24 hours. The Accreditation Council for Graduate Medical Education (ACGME), which accredits medical residencies, forestalled both regulation and legislation by its own voluntary program, implemented in July 2003. However, that program allows up to 88 hours per week of work, allows programs to average the work hours over a four-week period, and allows shifts of up to 30 hours. It does not include fines for violating programs, adequate transparency or protections for whistleblowers.
Today’s two landmark studies, both led by Dr. Charles A. Czeisler, document more clearly than any prior research the patient-endangering consequences of current work patterns. In the first study, “Effect of Reducing Interns’ Work Hours on Serious Medical Errors in Intensive Care Units,” interns in intensive care units in Brigham and Women’s Hospital at Harvard Medical School were randomized to traditional schedules or an intervention schedule that limited shifts to 16 hours.
Interns in the traditional schedule made 36 percent more serious medical errors than those in the intervention schedule. Many of the unnecessary errors were medication errors, which were 21 percent higher in the traditional group. The authors concluded: “Eliminating extended work shifts and reducing the number of hours interns work per week can reduce serious medical errors in the intensive care unit.” Earlier studies had shown that sleep-deprived residents were more likely to be depressed, to have injurious automobile crashes and to have problems with pregnancy.
In the second study, “Effect of Reducing Interns’ Weekly Work Hours on Sleep and Attentional Failures,” interns in the same rotations at Brigham and Women’s Hospital were studied in detail. During the intervention period, interns worked 20 fewer hours (65 hours compared to 85 hours) and slept six hours more per week. The interns also had more than 50 percent fewer episodes of attentional failures (eye-rolling during waking hours, measured by electrooculography) during the intervention period.
These two studies are the most compelling studies ever published in the area of resident work hours. They prove that reducing work hours is feasible and, more convincingly than any prior research, demonstrate that patients will benefit from the more humane treatment of residents. It is time for the federal government to step in to protect both patients and residents, rather than leave this major public health problem in the hands of the industry that is responsible for the problem in the first place.