Patient Safety Advocates Launch Campaign to Reduce Resident Physician Fatigue, Boost Patient Safety

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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 - 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

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


Public Citizen is a national, nonprofit consumer advocacy organization founded in 1971 to represent consumer interests in Congress, the executive branch and the courts.

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