The U.S. Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ) has issued a new Institute of Medicine (IOM) report stating that fatigued medical residents need "protected sleep periods and increased supervision of work hour limits to improve patient safety and the training environment."

According to an AHRQ press release, the report is the result of a 15-month study by an IOM committee. The committee investigated the relationship between medical resident's work schedules, performance and the quality of care the residents provide. The study confirms that scientific evidence shows "acute and chronically fatigued residents are more likely to make mistakes." The report is titled, Resident Duty Hours: Enhancing Sleep, Supervision and Safety.

The IOM committee has several recommendations for changes to existing 80-hour-per-week limit on work hours, including protected sleep periods for residents. The AHRQ release says the Accreditation Council for Graduate Medical Education's (ACGME) current rules allow residents to work a maximum 30-hour shift. During that time, medical residents may treat patients for 24 hours and engage in training or transition activities for the other six hours. The IOM now recommends a change to require residents who complete a 30-hour shift to only treat patients for up to 16 hours. The residents must then have a five-hour protected sleep period between 10 p.m. and 8 a.m. During that time, other non-sleeping residents or additional staff members could take over patient care.

"The Institute of Medicine study provides the clear evidence to prove what we have long-believed is true-fatigue increases the chance for human error," said AHRQ Director Carolyn M. Clancy, M.D. "Most importantly, this report provides solid recommendations that can improve patient safety, as well as increase the quality of the resident training experience."

Other recommendations from the report include: increased supervision of work hours; stronger moonlighting restrictions; guaranteed days off to permit adequate recovery after working long shifts; reasonable on-call periods; safe transportation provided by hospitals to residents who are too fatigued to drive home; increased resident training on better communication during handovers; and increased involvement of residents in patient safety activities and adverse event reporting.

AHRQ has a number of free resources on its website to help residents and other health care providers implement recommendations related to patient safety training and adverse event reporting.

Adapted from a press release by the AHRQ.

Read the AMA endorsement at:
https://www.dotmed.com/news/story/7707