A new UCLA study shows that physicians who work shorter shifts are less likely to make mistakes during medical procedures.
Dr. Christian De Virgilio, lead investigator at the Los Angeles Biomedical Research Institute at Harbor- UCL A Medical Center (LA BioMed), led a team that studied the medical records of 2,470 patients who had undergone laparoscopic gallbladder surgery. The study focused on operations that took place before and after rules were put in place in 2003 limiting hours worked by doctors. About half of the operations were performed before a reduction in hours, and the other half were performed after the reduction.
"We suspected that the outcomes would have been the same before and after," said Dr. De Virgilio. "Instead, the complication rate decreased. We are actually surprised to find the outcomes improved."
The UCLA study offers some of the first evidence that the rules put into place in 2003 establishing the current guidelines for physicians in training to work a maximum shift of 30 hours, with a maximum 80-hour work week, resulted in better care for patients. Previously, many doctors have argued that the limits interfere with the training of doctors but make no difference in patient care.
"The hard truth is that many hospitals do not adhere to the maximum allowable guidelines put in place in 2003," said Dr. Sean Darcy, University of California, Irvine (UCI) Surgical Resident and President of the Patient and Physician Safety Association. "In fact, many residents record their hours at below 80 and really work 80 hour weeks, and those that record otherwise or speak up are retaliated against by their superiors. Unfortunately, there is no real law to ensure the uniform standard being implemented by UCLA in accordance with the 2003 guidelines is actually being followed in other hospitals. The health care profession needs that type of enforceable law to make sure health care providers are not exceeding the maximum allowable hours and putting people's lives at risk. In the past year, there has been more attention given to air traffic controllers' sleep deprivation and the subsequent impact on the public than there has on the people tasked with performing surgeries and providing health care during what could be the most critical period of an individual's life."
In the past year, as a result of numerous documented cases of air traffic controllers sleeping on the job, Transportation Secretary Ray LaHood and the federal government stepped in to require additional time off between shifts. This critical step was taken in an effort to further ensure the public's safety.
"People entering a hospital are entrusting their own health and safety, or that of their loved ones, to the health care providers on call," said Darcy. "Unfortunately, many of the residents are under significant pressure to exceed the maximum allowed 30-hour shift and 80-hour work week. Tack on the additional responsibility of taking care of up to 100 patients that a resident only has a peripheral knowledge of, and you have an almost guaranteed system of patient harm. Patient care is a delicate balance requiring total awareness and complete focus on each patient's individual health care needs, two attributes that are significantly impacted by lack of sleep and multiple patients to be accountable for. From the moment a patient enters the hospital, they have placed themselves in the hands of well-trained health care professionals who are entrusted every day with life and death decisions. However, these health care professionals are human beings with the same basic human needs for sleep as anyone else."
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