Limiting Hospital Intern Shifts May Not Cut Errors, Studies Find

Article excerpt

It's been 15 years now, but Dr. Sanjay Desai remembers the brutal hours he worked as a young medical intern and how he struggled with fatigue while treating patients.

"There were days we were easily working 36 hours straight and you couldn't remember how you got home if you got home," Desai said. "It wasn't safe."

Times have changed. Regulations now demand that teaching hospitals limit first-year trainees to 16-hour shifts. By reducing work hours, medical authorities reasoned, interns would get more sleep, suffer less fatigue and commit fewer mistakes.

But a pair of studies published Monday in JAMA Internal Medicine suggest this may not be the case. Researchers concluded that interns were making more mistakes and learning less .

The problem, according to researchers, was that interns were required to do the same amount of work but in fewer hours. Shorter shifts also require more patient "handoffs" from one doctor to another. Handoffs, previous studies have demonstrated, are a common source of medical errors.

"I was surprised," said Dr. Srijan Sen, a University of Michigan Medical School psychiatrist and lead author of one of the studies. "It was clear that interns do not function optimally after working 24 hours in a row. So there was real hope that reducing the maximum shift length would help both interns and patients. However, our results suggest that the negative unintended consequences of the reforms may outweigh any positives."

The studies no doubt will add fuel to the debate over duty hour reforms.

In 2003, the Accreditation Council for Graduate and Medical Education reduced the maximum shift length for first-year residents, or interns, to 30 hours from 36. …