Residents’ working hours shortened as of July 2011

fatigue and residents, medical errorsWill policies to reduce medical residents’ fatigue may compromise quality of training? Is learning more important than fatigue-induced medical errors? The debate rages as we approach a deadline of July 2011, which will limit residents’ working hours to no more than 16.

Recent Accreditation Council for Graduate Medical Education (ACGME) limits aimed to enhance patient safety may compromise the quality of doctors’ training, according to a study by Mayo Clinic researchers published in the March issue of Mayo Clinic Proceedings (

Patient safety has long been a critical concern for hospitals, in particular for those training new doctors. Since 1984, when the death of 24-year-old Libby Zion at a New York hospital was attributed to an overtired medical resident, training programs have faced restrictions on the length of work shifts for the least-experienced medical doctors. Last year, the ACGME, which oversees residency programs, issued the most restrictive guidelines to date: Residents should serve no longer than 16-hour shifts in the hospital.

“Our results showed that the duty-hour limitations may not be a quick fix to an important problem,” says Mayo Clinic internist and co-author Darcy Reed, M.D., M.P.H. (

The survey sent to directors of residency programs around the country found that many are concerned that the duty-hour limitations to be implemented by July 2011 will impinge on physician education. Of the nearly 500 respondents from the fields of surgery, internal medicine and pediatrics, 87 percent of program directors felt that the shortened shifts will interrupt the interactions between residents and hospitalized patients. “Many survey respondents expressed concern that the limits will decrease the continuity of care. As residents face more handoff of responsibilities within a 24-hour period, they have less opportunity to see and learn how patients’ care progresses,” Dr. Reed says.

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Is this concern valid? Is this resistance to change? A doctor told me that limiting hours for residents did not prepare them for the “real” world after training was over. I would hate to be harmed, or see a person I loved harmed, by a well meaning but sleep-deprived resident.

See also “Long nursing shifts could harm you”. What do you think about limiting residents’ hours to 16?

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National Patient Safety Awareness Week

This column captures many of the components of being a patient safety advocate. Read the full column here.

When my daughter had surgery years ago, I packed up my PJs and pillow and camped out in the uncomfortable chair in her hospital room for 10 days. I was there to advocate for her and it was a good thing I was. One very early morning, a resident came in and started taking her for a test to explore some symptoms she was experiencing. I stopped him, insisting on waiting for her surgeon.

If she had undergone the procedure it may have caused lifelong complications. The number of preventable medical errors can be reduced if we as patients become more involved and invested in our own care.
be a good patient advocate to avoid patient safety problems
Sunday began National Patient Safety Awareness Week, an annual education and awareness campaign to promote health care safety. This year’s theme; “Are You In? Commit to Safer Health Care,” will again promote a collaborative relationship between patients, families and health care providers. Now more than ever the healthcare climate is calling for us to be proactive.

We really all need to be “Dr. Moms” to manage our own and our family’s health issues. Read more.

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Don’t rush to the delivery room

premature delivery, early delivery without medical necessityDon’t rush to delivery. That is the message to expectant parents as a result of a recent study of hospitals and known benefits of not delivering before the 39th week of pregnancy. Given that there are some medical indications for earlier delivery, Leapfrog Group established a patient safety goal of only 12% of deliveries occurring before the 39th week. Important development changes take place in the fetus’ brain and lungs during these last weeks of gestation.

Of the 773 hospitals who responded to a request to supply data about their delivery rates, numbers varied widely. More than half reported rates higher than 12%, with some having as high as 60%. Some hospitals declined to respond, leading one to wonder if they did not keep statistics, or their performance was poor on this indicator.

This kind of information is pointing to the standard of care being defined as discouraging early delivery without medical indication. Consider the risks to the fetus and to the mother when labor is induced or a cesarean section performed to meet the convenience factor.

A short term convenience for the mother or the obstetrician may result in long term complications when the fetus is between 37-39 weeks. The baby may not developmentally ready. Cesarean sections carry risk of bleeding, perforation of surrounding organs, anesthesia complications, need for repeat cesarean sections, and more. Increasingly, hospitals should be putting pressure on their obstetricians to not participate in early deliveries without medical necessity. And patients should be educated about the risks.

Read more.

Find out what rate your hospital reported- or didn’t.

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Remember to dance with joy

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Patient Safety Hindered by Low Nursing Staffing

Read the press release of concerned nurses at Tufts Medical Center in Boston:

It is with great interest for the future of Tufts Medical Center in Boston that the registered nurses of this hospital respond to the pending retirement of CEO Ellen Zane. The announcement comes just days after the nurses held a Candlelight Vigil where hundreds of nurses and their supporters gathered outside the facility to protest dangerous staffing conditions created by nursing leadership under the direction of Zane.

For nurses, our primary concern is for the safety of our patients. Under Ms. Zane’s leadership, particularly in the last two years, there has been an effort to cut costs at the expense of patient safety. Whether it is Ellen Zane, or someone else in charge, nurses are committed to fighting for desperately needed improvements in patient care conditions at this level one pediatric trauma and level two adult trauma center.

The nurses have serious concerns about recent cuts in RN staffing levels and other changes in how they deliver care that has resulted in nurses being forced to care for more patients at one time on nearly every unit. To compensate for chronic understaffing, TMC is using mandatory overtime, and is forcing nurses to “float” from one area of the hospital to another where they might not be competent to provide appropriate care.

Those changes transformed this hospital from being one of the best staffed hospitals in Boston to the worst staffed hospital in the city. No other institution in the city is operating ICUs where their nurses are expected to care for three patients, nor are they expecting their medical surgical nurses to carry assignments of up to seven patients on a regular basis.

The staffing changes have caused a dramatic deterioration in both the quality of care nurses are delivering and, in some cases, has resulted in serious lapses in care. In the past year alone, nurses have filed more than 520 reports of incidents that jeopardized patient care.

The nurses are outraged at the lack of regard for patient safety by the Tufts Medical Center administration. The nurses have had countless meetings with management to warn them about their concerns, and have sent two letters to the Board of Trustees appealing for their intervention to protect patients. Yet nothing is done to address this crisis.

The 1,200 RNs at TMC, who are currently in negotiations for a new contract, are seeking contractually guaranteed, safe staffing levels, and prohibitions against forced overtime and the inappropriate floating of nurses from one area of the hospital to another where they might not be competent to provide appropriate care — all of which are needed to ensure that patients at Tufts Medical Center receive the safe care they deserve.

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