Evidence-Based Resident Work Hour Changes Supported by Policy Experts
"The recent ACGME rules are based on stronger evidence that ought to inform policy of such reach.”
Health-policy experts are applauding the new revisions to residents' duty hours just issued by the Accreditation Council for Graduate Medical Education (ACGME).
The revisions limit resident workweeks to 80 hours, but also extend shifts from 16 to 24 hours — revisions that the ACGME says are based on evidence, not opinion.
“What is meaningful about the recent ACGME rules is that they are based on stronger evidence and on a more disciplined approach to developing the kind of evidence that ought to inform policy of such reach,” say lead author David Asch, MD, MBA, professor of medicine at the University of Pennsylvania and the Philadelphia VA Medical Center, both in Philadelphia, and two coauthors in a recent review in The New England Journal of Medicine.
Widespread debate and the development of policies regulating resident duty hours was first prompted by a jury decision in 1984, which ruled that the death of an 18-year-old hospital patient was due to long resident hours and poor supervision of graduate medical education, the authors explain.
Designing regulations to reduce sleep deprivation, thereby addressing one cause of errors, has been a major focus for the ACGME, they write.
However, the authors argue, policies also need to reduce patient handoffs between shifts — another cause of medical errors — to as few as possible and to prevent medical residents from entering a “shift mentality,” which the authors say can reduce professionalism.
At the same time, policies guiding resident work need to make sure that hospitals continue to receive the affordable labor that is provided by residents and that they depend on, the authors add.