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Hospital Residents Still Overworked

Two studies in the Journal of the American Medical Association have found that limits placed the hours hospital residents may work have done little to reduce mortality rates of patients. 

On July 1, 2003, new guidelines from the Accreditation Council for Graduate Medical Education (ACGME) went into effect.  These limitations, listed here, prevented residents from working more than 80 hours a week, gave them one day a week free from all duties, prohibited 24 hour shifts, and required at least 10 hours between duty periods.

The ACGME was prompted to make this move because of the extensive data linking fatigue to impaired performance and increased errors among hospital staff.  However, these recent studies have shown that the new standards have done little, if anything, to impact mortality rates.

One study measured the frequency of death within 30 days of hospital admission for all patients admitted for acute myocardial infarction, stroke, gastrointestinal bleeding, congestive heart failure, general surgery, orthopedic surgery, or vascular surgery.  The five-year study included over 12 million patients at nearly 6,000 United States non-federal hospitals.

This study concluded that the implementation of duty hour limitations was not associated with any significant change in mortality rates.  However, the study did not address what might happen if the resident’s hours are further limited.

The second study addressed the same issue, but used Veterans Affairs hospitals as the sample set.  This study did find that in four of the categories studied, the implementation of duty hour limitations was statistically significant.  Shannon Brownlee, writing for Washington Monthly believes that the reason for this is that Veterans Affairs hospitals have a functioning electronic medical records system which allows physicians to access the patient’s entire medical record.

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