Research suggests that longer shifts for residents and doctors may cause dangerous levels of impairment, putting patients needlessly at risk.
Since the highly publicized death of patient Libby Zion at New York Hospital in 1984, the lengthy shifts that doctors and residents work has been a source of controversy. Critics have long contended that allowing doctors to treat patients for upwards of 24 straight hours can cause issues with memory and judgment, leading to adverse outcomes that could have been avoided with more sensible scheduling. Now, new research supports the assertion that longer shifts can put patients at risk.
Severe impairment
The recent study from the American Automobile Association Foundation for Traffic Safety examined how sleep deprivation affects a person’s driving performance. It found that, compared to people who had slept seven hours in a 24-hour period, those who slept five or six hours were twice as likely to crash. Sleeping four or five hours quadrupled a driver’s crash risk, and for people who slept fewer than four hours, the likelihood of an accident was 12 times higher.
Given these findings, AAA now recommends that motorists avoid driving when they have not slept for at least seven hours in the past 24 hours. This calls into question whether doctors who are even more sleep-deprived are fit to make life-and-death decisions when treating their patients, which is arguably a more difficult task than driving.
Prior research focused specifically on the medical field similarly suggests that the exhaustion resulting from long shifts can endanger patients. According to EHS Today, doctors working shifts of at least 24 hours have the same effective performance as doctors who are legally intoxicated. Their risk of making serious missteps, such as
missed or incorrect diagnoses, drug errors and surgical mistakes, increases over 300 percent.
Ongoing controversy
In light of finding such as these, the Accreditation Council for Graduate Medical Education issued guidelines in 2011 that reduced the maximum shift length for residents. Under these standards, first-year residents can work at most 16 hours per shift, while other residents can work up to 24 hours. Still, doctors may work longer shifts. Also, supporters of these hours have pushed for bringing resident shifts back to 30 hours, arguing that the prior changes did not improve outcomes for patients.
The Washington Post notes that this may be the case not because longer shifts are optimal, but because the ACGME guidelines have not addressed other serious issues, including:
· Inadequate staffing. Many hospitals have not hired more staff to accommodate the shorter hours that residents work. This forces residents to complete the same share of work in less time.
· Lack of training. To safely "hand off" patients more frequently, residents and doctors may need additional training, but this is often lacking.
· Long hours. Residents can still work a maximum of 80 hours per week, so they are not necessarily getting more time to rest – rather, they are working more brief, frequent shifts.
Sadly, allowing medical professionals to work longer shifts instead of addressing these issues may expose patients to unnecessary errors, oversights and adverse outcomes.
Getting help
When a physician gives a patient treatment that falls below an acceptable standard of care, he or she may be liable for any resulting injuries. However, pursuing a medical malpractice claim in New York can be complex. Patients must typically file claims within 30 months, and they also must provide a “certificate of merit” stating that a qualified medical professional has reviewed the claim and found it valid.
Both processes may leave room for errors that hurt a person’s case. Consequently, victims of medical mistakes or negligence may benefit from consulting with an attorney for advice on navigating the claim process.
