In 2011, the Council for the Accreditation of Higher Medical Education (ACGME) limited the working hours of first-year resident physicians to no more than 16 consecutive hours after studies showed that longer-term changes could increase the risk of medical errors and other adverse outcomes. The response to the restriction was mixed, and it was lifted in 2017, again allowing residents to schedule uninterrupted work for up to 24 hours. A new study examines the impact of a 16-hour limit on patient safety outcomes that are directly under the supervision of resident physicians. Through national population surveys before (2002-2007) and after (2014-2017) the restriction was enforced, the team found that medical errors and adverse events reported by resident physicians were reduced by more than a third, and medical the errors that led to the patient’s death were reduced by almost two-thirds when the 16-hour limit was introduced. The results are published in BMJ quality and safety.

“We know that people tend to earn more errors if they are sleep deprived and doctors are no exception, “said lead author Matthew Weaver, Ph.D., assistant epidemiologist in the Department of Sleep and Circadian Disorders.” Importantly, we see that activities such as work time restrictions can have a significant effect. In our study, we saw a dramatic reduction in the number of medical errors that resulted in harm or death of a patient when working hours were limited. It is important that the risk of long-term work changes and the potential benefits of limits are transparent to patients and providers. ”

The authors conducted their national prospective survey, addressing all U.S. medical school graduates and all additional individuals who met the U.S. residency program. More than 21,000 agreed to attend (9% of all U.S. medical residents in 2002-2007 and 18% of U.S. medical residents from 2014-2017). After monitoring age, gender, specialty, and other variables, including patient care time, the team found that after the introduction of working time policies, the number of reports of significant medical errors decreased by 32% and the number of preventable reports by 34%. . adverse events, and a 63% reduction in the number of reported medical errors that resulted in the patient’s death. The authors note that the study is observational in nature and relies on self-reports that may be subject to bias and misconceptions.

The new study builds on previous work by researchers from the Department of Sleep and Circadian Disorders. Their previous research helped substantiate ACGME’s 2011 decision and examined the detrimental effects of extended working hours for both patients and residents.

“We have studied both extended changes – working more than 24 hours in a row – and extended ones working hours– for example, work more than 60 hours a week – and have seen evidence of harm not only to patients but also resident“The doctors themselves,” said senior author Laura Barger, Ph.D., an associate physiologist in the Department of Sleep and Circadian Disorders. Car accident after the change. “

Weaver, Barger and colleagues plan to study the impact of lifting working time limits after 2017. Their next cohort will include responses to a survey of residents from 2020 to 2023 and examine how many hospitals are now using extended work shifts.

“Now that national norms again allow up to 24 hours in a row for freshmen, it is important to continue efforts to monitor the consequences, especially on medical errorsand expand this monitoring to assess the health and well-being of residents, ”Weaver said.