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Study seeks to show how shift length of medical residents affects patient safety

Ongoing research may help settle a debate about how changes in the shift lengths of medical residents affect patient health and safety.

For years, the number of hours that medical residents in Illinois and other states work has been a point of controversy. Some safety advocates contend that overly long shifts increase the likelihood of fatigue-related errors that harm patients. Others maintain that shorter shifts lead to more frequent patient “hand-offs,” which pose the greatest safety risk of all. Now, research is seeking to conclusively determine how changes in residents’ hours affect patients.

Conflicting data

Previous research suggests that sleep-deprived residents may be dramatically more likely to make mistakes that endanger patients, such as prescription medication errors. According to The Baltimore Sun, one set of studies indicated that, compared to residents who were limited to 16-hour shifts, those who worked over 24 hours made at least 300 percent more fatal errors that were at least partly due to fatigue. General mistakes also increased about 36 percent among these residents.

In light of findings like these, the number of continuous hours that residents can work has been capped in recent years. Since 2011, first-year residents have been limited to working 16-hour shifts, while second- and third-year residents have been permitted to work up to 24 hours in a stretch. However, some experts are now questioning whether these shorter shifts have their own dangers.

A 2013 study from Johns Hopkins University concluded that shorter shifts cause doctors to hand off care of their patients more frequently. This can increase the risk of adverse outcomes, such as missed or incorrect diagnoses, arising due to miscommunication. The same study found that shorter shifts can reduce residents’ training time, and troublingly, they are not associated with an increase in sleeping hours. As a result, the gains associated with these shifts might not offset the risks.

Current research

An ongoing large-scale study, which more than 60 medical institutions have opted to participate in, is attempting to determine which type of resident scheduling is more beneficial for patients. According to The Baltimore Sun, the study is comparing the alertness, safety, test scores and education of residents who are working maximum shifts of 16 or 28 hours. The research also is tracking the following patient metrics:

  • Length of time that patients remain hospitalized
  • 30-day readmission rates
  • 30-day mortality rates

Some patient advocates have objected to the research, however, citing ethical concerns. Currently, participating patients are not informed of the study or given the opportunity to decide whether they want to take part. This is troubling, given the documented risks associated with extremely long resident shifts.

Getting help

This ongoing research underscores the fact that many variables can put patients at risk, from excessively long shifts to poor continuity of care. Sadly, it is not uncommon for related issues, such as fatigue and ineffective communication, to cause medical professionals to make unnecessary mistakes. When these errors fall below an acceptable standard of care, a professional may be considered liable for any resulting injuries or complications.

In Illinois, holding a physician responsible for negligent care can be challenging. Victims generally must have a qualified expert evaluate the case and confirm its merit before a claim can be filed. Plaintiffs also must meet relevant statutory deadlines and establish the standard of care that a professional should have met. Considering these issues, most victims can benefit from working with an attorney who can help gather evidence and provide other assistance during the claim process.