September 10, 2008 Medical errors prompt work restrictions for doctors Play video

(Ally Donnelly, NECN) - Five years ago the national board that oversees the training of medical residents in hospitals decided the doctors-in-training were pulling too many all nighters.

The board restricted the number of hours residents were allowed to work, but now congress is asking did it go far enough?

Thousands of Americans are still dying from medical errors every year -- prompting some to call for shorter hours and more shut eye for the residents who care for them.

The term "medical resident" came from a time when doctors in training actually lived at the hospital. A concept that doesn't seem so foreign to Dr. Raquel Reyes.

By the end of a 30-hour shift...coffee is helpful.

Reyes is a first year resident at Mass General Hospital for children in Boston and says when she works more than 24 hours in a row -- she tries to limit her tasks to paper work -- avoiding direct patient care.

Dr. Reyes: I'm not as functional for sure. My response time is not as good my brain just doesn't work well.

Dr. Colin McCreight I'm not as well rested, it's harder to pay attention to the smaller details...I think things can fall through the cracks.

It is an age-old problem in medicine -- residents pulling long hours -- potentially putting themselves and *patients in harm's way.

In 2003, the residents' governing body---- the accreditation council for graduate medical education -- took action -- mandating -- among other things ---

that residents can not work more than six days in a row, more than an average of 80 hours a week or more than 24 to 30 hours straight.

Dr. Landrigan We know that 24 consecutive hours leads to a 36% increase in serious medical errors, more than 400% increase in serious diagnostic errors that residents make, they crash their cars twice as often when they're driving home from work and suffer 61% more needle stick injuries.

DR. CHRISTOPHER LANDRIGAN IS THE DIRECTOR OF SLEEP AND PATIENT SAFETY AT BRIGHAM AND WOMEN'S HOSPITAL IN BOSTON AND SAYS NEARLY 100 THOUSAND AMERICANS DIE EVERY YEAR BECAUSE OF MEDICAL ERRORS.

Residents themselves report making 4X as many serious medical errors that lead to the death of a patient when they've been up more than 24 hours.

A just-released report in the journal of the American medical association says that even with the 2003 mandate, the rate of medical errors and adverse patient events are still not improving. *congress has now commissioned a task force to investigate if residents hours need to be cut back *even further* and a Massachusetts lawmaker has proposed the state enforce its *own restrictions.

Dr. Landrigan Ideally the form that that would take would be shift limits on the outside of 16 to 18 consecutive hours. And really in some circumstances they ought to be less than that -- particularly ICUs, emergency rooms and other high intensity settings.

Dr. Johnson it's difficult for residents who are involved in a critical patient care issue to look at their watch and say -- oh -- time's up, I gotta go.

Dr. Scott Johnson heads the surgical residency program at Beth Israel deaconess. The Boston teaching hospital could lose it's accreditation by the ACGME for surgical training --- because it has repeatedly violated the "hours mandate." he says some of the violations are due to poor hospital oversight, but some are because residents themselves don't *want to go home. Landrigan also points out that the same body that monitors compliance is also in charge of accreditation.

There's a strong disincentive for residents to frankly report their hours when they know that if they acknowledge working 34 hours instead of a 30 hours shift, they're at risk of their program being shut down.

Johnson believes B.I has fixed the problems, but worries that shorter hours could mean surgical residents don't train consistently -- performing an operation over and over again -- day in and day out.

When you've got residents working 30 hours a week you're going to do a hernia Monday, you're gonna do a hernia next week, you're going to do a hernia the month after and maybe one a year down the road. You're not going to develop the skill or be able to maintain those skills in that type of model.

Debora Weinstein/MGH You might think reducing the number of hours will make people learn better because they're less fatigued, but it also reduces their opportunities to see a rare surgical intervention or be with a patient to see the consequences of the procedures or the medications that they've put into place.

Dr Deborah Weinstein heads up the resident training program at mass general which has also been cited for hours violations.

When there's a choice between taking care of a patient and perhaps breaking a rule, we will always take care of the patient.

There are more than 5K residents at area hospitals in MA alone -- a huge, cheap work force. if their hours are cut back even further -- who will fill the gap and how much will it cost?

Dr. Johnson/BIDMC Numbers that we're seeing are 10, 15, 20 million dollars per institution.

Michael Mazzini there's an infinite demand, there's a limited number of interns and residents and unfortunately until you balance who's going to do the work and who's going to take care of patients, there's going to be that tension.

Dr. Michael Mazzini is with the medical residents union and says spreading out residents' responsibilities may be one way to shorten hours but maintain quality patient care.

Restructuring a training program so that you're spending more time in the operating room and less time doing menial tasks would be very, very important.

Mazzini suggests better use of technology to automate more of those menial tasks, but admits there will likely be a need for nurses or physicians assistants to do some of the work. But hospitals wonder -- in a widespread healthcare worker shortage -- where will they come from and who will pay for it? Patients?