RESEARCH - Study links errors by doctors to long hours

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Study links errors by doctors to long hours

Monsters and Critics

By Will Dunham Dec 13, 2006, 0:16 GMT

WASHINGTON - The marathon hours worked by doctors-in-training in U.S.

hospitals are leading to an alarming number of fatigue-related medical

errors that often kill patients, researchers said on Tuesday.

When medical interns work shifts lasting from 24 to 30 hours, the risk of

them committing serious medical mistakes that harm patients skyrockets,

researchers at Brigham and Women's Hospital in Boston found.

The interns were 4.1 times more likely to have made fatigue-related medical

errors that resulted in a patient's death after working five or more of

these shifts per month than in a comparable month when they did not work

such long hours, the researchers found.

The study cast a new spotlight on a practice dating back to the 1890s in

U.S. hospitals of compelling young doctors-in-training to work extremely

long shifts.

Supporters of the practice say it is vital for a new doctor to follow

individual patients for the entire course of a hospital stay, in part to

learn about the courses of various illnesses.

The findings were based on a survey of 2,737 interns of various medical

specialties in U.S. hospitals.

'We found that for every 100 interns working for a year, they on average

made 200 significant medical errors, 20 significant medical errors that

caused a preventable injury to their patients and 5 serious medical errors

that caused the preventable deaths of their patients,' Dr. Czeisler,

who led the study, said in a telephone interview.

If these findings are applied to all 100,000 young doctors working such

schedules at U.S. hospitals, he said, that means there are nearly 100,000

significant medical mistakes, tens of thousands of preventable injuries to

patients and thousands of preventable deaths that are fatigue-related every

year.

Czeisler is chief of the Division of Sleep Medicine at Brigham and Women's

Hospital and a professor at Harvard Medical School. The study appears in the

Public Library of Science journal PloS Medicine.

The mistakes do not reflect an intern's medical knowledge, but rather are

mental slips and lapses typical of exhaustion, Czeisler said.

The study examined the issue of these doctors-in-training working within

work-hour limits established by the Accreditation Council for Graduate

Medical Education.

The organization has put in place work-hour guidelines for U.S. interns,

limiting them to a maximum of 30 straight hours and a maximum of 80 hours

per week averaged over four weeks.

'Considered as a whole, the evidence demonstrates that academic medicine, by

clinging to this 19th century tradition, is failing both doctors and their

patients by routinely requiring exhausted doctors to work these marathon

30-hour shifts,' Czeisler said.

'The human brain simply does not perform reliably for 30 consecutive hours

without sleep.'

The Service Employees International Union, the largest union for medical

interns and residents at U.S. hospitals, said the findings are even more

frightening because hospitals are permitted to schedule interns to work a

shift lasting 24-30 hours as frequently as two to three times per week.

The union repeated its call for legislation from the U.S. Congress to impose

limits on resident work hours.

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Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org