Saturday, May 01, 2010
Institute of Medicine (IOM) guidelines restricting the number of hours medical residents can work may not result in the intended consequences of enhancing sleep and patient safety.
The first study of these 2008 guidelines shows that average sleep time is unaffected and that work-life balance actually worsens.
The Cincinnati Children’s Hospital Medical Center study will be presented at 4 p.m. ET Saturday, May 1, at the annual meeting of the Pediatric Academic Societies in Vancouver, Canada.
"Proposed IOM recommendations had no significant effect on average sleep time during any 24 hour period," says Katherine Auger, MD, a physician at Cincinnati Children’s and the study’s main author. "The pattern of sleep, however, did change. Residents had more frequent blocks of consecutive sleep, which may potentially improve fatigue and safety. On the other hand, work-life balance worsened, which may be due to an unanticipated increase in work load intensity."
The 2008 IOM report proposed revisions to residents’ duty hours and an increase in their supervision to reduce the chances of fatigue-related medical errors and to enhance the learning environment for doctors in training.
Dr. Auger and her colleagues studied first-year residents (interns) on general pediatric inpatient teams at a large children’s hospital over a one-month period. Some of the interns worked a schedule that complied with the 2008 IOM guidelines, including a maximum shift of 12 hours, at least 24 hours off every seven days, and no more than three consecutive night shifts. Other interns worked a 30-hour call schedule every fourth night. All kept sleep logs.
In the pre-IOM group, 67 percent of the interns indicated their work-life balance as good, very good, or excellent, compared to 20 percent in the IOM group. Also, 40 percent of those in the pre-IOM group rated their daily workload intensity as very low, low or neutral, compared to 0 percent of the IOM group.
"Given the contradiction in work-life balance, further work is needed to determine whether and how much increased staffing will prevent detrimental work-load intensity from undermining potential benefits to well-being and less fatigue," says Dr. Auger.
Complete survey results are as follows:
|IOM group||Pre-IOM group|
|Average sleep reported per 24-hour period||7.8 hours||7.6 hours|
|Percent reporting having slept at least five consecutive hours in 24-hour period||79||57|
|Percent reporting having slept at least five consecutive hours in 24-hour periods without being paged||91||73|
|Percent of interns reporting fatigue level as low or very low||40||0|
|Percent of interns reporting feeling well-rested as somewhat likely, very likely or always||60||20|
|Percent of interns reporting likelihood of mistakes due to fatigue as never or not very likely||80||40|
|Percent of interns rating average daily workload intensity as very low, low or neutral||0||40|
|Percent of interns reporting work-life balance as good, very good or excellent||20||6|
Cincinnati Children’s Hospital Medical Center is one of 10 children’s hospitals named to the Honor Roll in U.S. News and World Report’s 2009-10 America’s Best Children’s Hospitals. It is ranked #1 for digestive disorders and highly ranked for its expertise in respiratory diseases, cancer, neonatal care, heart care, neurosurgery, diabetes, orthopedics, kidney disorders and urology. Cincinnati Children’s is one of the top two recipients of pediatric research grants from the National Institutes of Health (NIH). Internationally recognized for quality and innovation by The Joint Commission, the Institute for Healthcare Improvement and the federal Agency for Healthcare Research and Quality, it has collaborations with hospitals and health systems around the world. . Additional information can be found at www.cincinnatichildrens.org.