First-year residents reported that working five extended-duration shifts--of 24 hours or more at a time without rest--per month led to a 300% increase in their chances of making a preventable adverse event that contributed to the death of a patient, according to a new study funded by the Agency for Healthcare Research and Quality and the National Institute for Occupational Safety and Health. Unlike previous studies that have suggested a link between resident work hours and medical errors that harmed patients, this study has a sample size large enough to demonstrate that the rate of preventable adverse events grows when interns work shifts of 24 hours or more.
According to the study, interns were three times more likely to report at least one fatigue-related preventable adverse event during months in which they worked between one and four extended-duration shifts. In months in which they worked more than five extended-duration shifts, the doctors were seven times more likely to report at least one fatigue-related preventable adverse event and were also more likely to fall asleep during lectures, rounds, and clinical activities, including surgery. Guidelines for graduate medical education in the United States allow up to nine “marathon” shifts (30 hours at a stretch) per month, even though the total number of hours worked is capped.
Researchers analyzed the results of a national, web-based survey in which 2,737 interns completed 17,003 monthly reports, and they assessed the association between the number of extended-duration shifts worked in the month and the reporting of significant medical errors, preventable adverse events, and lapses of attention. Read the press release.
