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Patient Safety Advocates Launch Campaign to Reduce Resident Physician Fatigue, Boost Patient Safety
Groups Call for Shorter Shifts and More Supervision, Create Web Site to Solicit Public’s Involvement
WASHINGTON - February 4 - A coalition of public interest and patient safety groups launched a campaign today to increase public awareness and gather stories about patients who have received inferior medical care from fatigued physicians.
At www.WakeUpDoctor.org, which went live today, the public can get background information about the correlation between physician sleep deprivation and patient safety, share stories and sign on to a letter expressing support for commonsense regulations to reduce the number of work hours and enhance supervision of resident physicians.
Public Citizen, Mothers Against Medical Errors and other patient advocates also sent a letter to the Accreditation Council on Graduate Medical Education (ACGME), the group that oversees the training of physicians in the U.S., calling for shorter shifts and more supervision of resident physicians (also known as medical residents) in an effort to boost patient safety. More than 40 health care, patient safety and other public interest advocates have signed the letter.
In a telephone news conference today, residents and experts spoke about the dangers posed by medical residents working shifts as long as 30 hours, frequently with limited support or supervision, leaving them exhausted and prone to mistakes. Residents may work as many as 10 of these 30-hour shifts a month.
"Few, if any, people would fly on a plane whose pilot had been awake and working for 25 to 30 hours. Federal regulations prohibit pilots from flying more than 30 to 35 hours a week," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. "But because medical residents work on shifts lasting as long as 30 hours straight, they become fatigued, making them more susceptible to making errors that greatly harm patients. It is likely that there are more deaths in U.S. hospitals each year caused by sleep-deprived doctors than the total annual deaths from plane crashes and train accidents."
The scientific evidence linking acute and chronic sleep deprivation with preventable medical errors has mounted steadily over the years, Wolfe said. "Reducing the length of their shifts is the commonsense approach that both the medical field and consumers need."
The Institute of Medicine (IOM) in December 2008 issued a landmark report, "Resident Duty Hours: Enhancing Sleep, Supervision and Safety." The comprehensive review listed 10 recommendations for change, including an increase in supervision of junior residents and a significant reduction in work hours - from 30-hour shifts to shifts no longer than 16 hours. The ACGME board of directors will meet Feb. 7-9 to discuss changing its policy on work hours in light of this report.
Ample evidence has shown that marathon shifts in excess of 16 hours can have a detrimental effect on a physician's abilities and judgment.
"After 24 hours without sleep, attentional failures at night double and impairment of reaction time is comparable to the impairment induced by drinking alcohol," said Dr. Chuck Czeisler, a professor and director of sleep medicine divisions at Harvard Medical School and Brigham and Women's Hospital. "The clinical performance of physicians - who are used to being at the top of the class - drops to the seventh percentile of their rested performance. Yet, as with alcohol, those affected by sleep loss often do not recognize their impairment."
In 2006, the Harvard Work Hours, Health and Safety Group at Brigham and Women's Hospital in Boston reported that one in five first-year resident physicians admitted making a fatigue-related mistake that injured a patient. One in 20 admitted a fatigue-related mistake that resulted in a patient's death.
"Considerable scientific evidence backs up what common sense tells me: that life and death decisions should not be made by someone who is sleep-deprived," said Dr. John Ingle, fourth-year ear, nose and throat resident at the University of New Mexico and regional vice president of the Committee of Interns and Residents/SEIU Healthcare. "My patients are consistently horrified when they learn that I haven't gone to sleep since they saw me the previous day."
Many suspect that a major factor leading to these exorbitantly long shifts is tradition in the medical field; because seasoned doctors had to endure long hours when they were training, they believe incoming physicians should be subject to the same conditions.
Helen Haskell, the founder and president of Mothers Against Medical Error, became involved in patients' rights after her 15-year-old son died from a preventable medical error. When her son went to the hospital for an elective procedure in 2000, he died from "failure to rescue," or failure to recognize and act upon the signs of serious decline in a patient.
"I know that fatigue must have played a role in my son Lewis's intern's judgment and in her inability to buck the system for the sake of a patient," said Haskell. "There is no way I can ever know how large a role it played, but I do know that in those hours of crisis, the last thing we needed was to have an exhausted, unsupervised young trainee as my dying child's only lifeline."
Another well-known case of a fatal medical error was that of Libby Zion, an 18-year-old whose 1984 death in a New York City hospital spurred new limits for resident work hours. After Zion's death, her father, journalist Sidney Zion, brought charges against the hospital and the physicians, indicting the medical training system for excessive work hours and poor supervision that, he argued, contributed to poor judgment and medical negligence. As a result of Zion's crusade, New York state has stronger work hours rules than the rest of the country.
For current and future resident doctors, these are cautionary tales. "Medical training must promote supportive teamwork, not rugged individualism," said Daniel Henderson, health justice fellow at the American Medical Student Association. "Try as we might to ignore our own limits, all doctors are humans, and we all need sleep."
Other industries impose limits on the hours employees work in a given shift to prevent fatigue-related accidents. It's time for the medical field to follow suit.
"Federal regulators and the airline industry long ago recognized that pilots and crews should not have unlimited duty hours. As a result, flight crews' duty time is closely regulated so as to minimize the potential for crew fatigue and its potential lethal consequences," said Art Levin, director of the Center for Medical Consumers and a reviewer of the IOM report. "Patients and medical residents deserve the same protection."
To learn more, to share stories and to sign the letter to the ACGME, visit www.WakeUpDoctor.org.