Reducing resident hours may have unintended negative effects
Reducing medical resident duty hours may have unforeseen consequences; changes must be made carefully and evaluated rigorously to ensure patient safety and resident well-being, according to an analysis published in CMAJ (Canadian Medical Association Journal) .
Canada's National Steering Committee on Resident Duty Hours recently released recommendations to help inform a discussion on the issue. The United States and Quebec have reduced resident duty hours because of concerns over patient safety and resident quality of life. Residents in Quebec now cannot work more than 16 hours in hospital, compared with about 24 hours in the rest of Canada plus 2 hours for handover of patient care information.
Concerns that patient care may suffer under the watch of sleep-deprived residents are not borne out by existing evidence, much of which is conflicting over the perceived benefits of fewer hours. As well, residents report less time to learn the practice of medicine.
"Although residents assigned to...the newer models [of reduced duty hours assessed in the United States] had more sleep, they also reported a decrease in educational opportunities, more frequent handoffs disrupting continuity of care and, most important, a perceived decrease in the quality of care," writes Dr. Reena Pattani, chief medical resident, St. Michael's Hospital, University of Toronto, with coauthors. "Nurses also reported that they perceived the quality of care provided in the new models to be worse."
Reducing resident hours may also increase the workload of staff physicians, which might reduce time for teaching.
"Although the National Steering Committee on Resident Duty Hours challenged the notion of a 'one-size fits all' solution, in doing so it has left out important details, such as how individual residency programs should design plans for fatigue risk management," the authors write. "Will scheduled naps during 24-hour call shifts be sufficient, or will residency programs inexorably move toward shifts that are no longer than 16 hours?"
"In academic health science centres in Canada, where much of the care is provided by residents, directors of individual residency programs are faced with a small and nondirective body of evidence as they begin to make changes to their residents' schedules. Rigorous evaluation will be required to learn how we can achieve the goals of improved quality of care and resident well-being while guarding against unintended negative consequences," the authors conclude.