Friday, May 7, 2010

Resident/Interns Making Life and Death Decisions while Exhausted and Sleep Deprived

The November 1999 report of the Institute of Medicine (IOM), entitled To Err Is Human: Building A Safer Health System, focused a great deal of attention on as many as 44,000 to 98,000 people die in hospitals each year as the result of medical errors. Medical Errors are the eighth leading cause of death. More people die each year due to medical error than die due to work related injuries and even more than die in automobile accidents. These medical errors can occur outside the hospital in other medical settings and even at home as there are medical errors in the writing and filling of prescriptions. The Massachusetts State Board of Registration in Pharmacy estimated that 2.4 million prescriptions are filled improperly each year in the State. See the IOM reporton Medical Errors was issued in February 2000 http://www.ahrq.gov/qual/errorsix.htm.

What are medical errors? Well it can be a botched surgery, amputation of the wrong limb, an wrong medication dose given, ordering the wrong diagnostic test or forgetting to order a diagnostic test, poor infection control leading to nosocomial or post-surgical wound infections, giving the wrong blood unit to a patient, improperly adjusting IV fluid flow, misinterpretation of a test and failure to act on abnormal results.

So how do you feel about the idea that a resident/intern in charge of decisions that affect you or your loved one has been sleep deprived and is exhausted? It is clear all rational decision makers that a doctor who is unable to get adequate rest will probably start making mistakes. In the hospital environment this can lead to medical error and even patient death. Rather than hiding the truth of medical errors we need to address this problem head on and need to address the abusive system of on call duty and lack of sleep time for resident/interns.

There is a new study out call Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, http://www.iom.edu/residenthoursthe most comprehensive study of resident work hours conducted to date. According to this recent Institute of Medicine study there are many abuses of scheduling of the more than 100,000 resident physicians in teaching hospitals across the country. Often in the U.S.A. these interns and residents are routinely scheduled to work shifts of 24-30 consecutive hours, with little or no sleep. They work in operating rooms and ER’s on the wards and in clinics. According to the study, the residents/interns when they are done their 12 hour or longer shifts, they potentially face back to back “on-call shifts” that can be 30 hours long. This brutal schedule leaves them sleep deprived and deeply fatigued interns and residents make mistakes thus impacting quality of medical care and safety. The rising level of medical errors in the USA is a testament to this real problem of quality of patient care and safety. Marathon work hours are linked to significant increase in failures of attention, performance deficits and medical errors. Driving back to their homes after an exhausting day at work leads to increased car accidents. The study reviews the robust evidence base linking fatigue with decreased performance in both research laboratory and clinical settings and makes a number of important recommendations for changes in the current system of training physicians. These include new limits on resident physician work hours and work load, increased supervision, training in structured hand-overs and quality improvement systems, more rigorous oversight and the identification of expanded funding sources necessary to successfully implement the recommended reforms.

There is a human cost to medical error in injury, increased sick time, days off work, and even death due to medical errors. This is a huge problem for our health care system, one which costs about $37.6 billion each year; about $17 billion of those costs are associated with preventable errors. Imagine how much more efficient and economical our medical system would be if we could prevent the expenses related to medical error which account for direct health care costs.

Medical error is often not attributable to individual negligence or misconduct. The key to reducing medical errors is to focus on improving the systems of delivering care and not to blame individuals. Health care professionals are simply human and, like everyone else, they make mistakes.

For more information on medical errors, select http://www.ahrq.gov/qual/errorsix.htm

See also the landmark research conducted by Lucian Leape, M.D., and David Bates, M.D., and supported by the Agency for Health Care Policy and Research, now the Agency for Healthcare Research and Quality (AHRQ).


Medical Errors: The Scope of the Problem. Fact sheet, Publication No. AHRQ 00-P037. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/errback.htm The prestigious Institute of Medicine (IOM) in December 2008 released its landmark report, Additional information on Resident Duty Hours: Enhancing Sleep, Supervision, and Safety can be found at http://www.iom.edu/residenthours. Copies of the report are available from the National Academies Press; tel. 202-334-3312 or 1-800-624-6242 or on the Internet at http://www.nap.edu. In addition, a podcast of the public briefing held to release this report is available at http://national-academies.org/podcast.

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