Controversy arises over residents’ sleep

Fatigued medical residents need protected sleep periods and increased supervision of work-hour limits to improve patient safety and their training environment, according to a new Institute of Medicine report.

The study, which was funded by the Agency for Healthcare Research and Quality, reviewed the relationship between resident work schedules, their performance and the quality of care they provide. Not surprisingly, the study confirms that scientific evidence shows fatigued residents are more likely to make mistakes.

Recommendations include changes to the existing 80-hour-per-week limit on work hours, such as protected sleep periods. The Accreditation Council for Graduate Medical Education’s rules allow residents to work a maximum 30-hour shift. The IOM recommends a change to require residents who complete a 30-hour shift to only treat patients for up to 16 hours. They must then have a five-hour protected sleep period between 10 p.m. and 8 a.m.

However, Public Citizen Health Research Group chastised the IOM approach. “Giving the ACGME, a group with neither the appetite nor the ability to enforce significant work-hour reductions, the primary authority over resident work hours creates an irresolvable conflict of interest,” the group says.

The consumer group also complains that ACGME enforcement of existing guidelines has been lax and enforcing a guideline on sleep within shifts will be even more difficult by maintaining that sleep will not be “protected,” and that “protected sleep” programs have limited impact on total sleep time and no impact on objective measures of alertness and performance.

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