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Shorter Shifts Might Lead to More Mistakes for Residents

Update Date: Mar 26, 2013 10:26 AM EDT

It is common belief that medical residents and interns made more mistakes due to the lack of sleep. The long hours of work and lack of sleep combination can lead to the loss of concentration and efficient cognitive skills, which prompted hospitals to change up their schedules and give time back to these doctors-in-training. However, according to new research, residents who had more time to sleep and less time on the job actually made more medical errors, leaving researchers and hospital confused over what to do.

Previous studies showed that long hours of continuous work could lead to fatigue and stress, which negatively affects performance levels. Due to these findings, the 2011 regulations cut the hours for first-year residents from 24 to 16. The difference of eight hours did not seem to have a beneficial effect on the residents, as new research reports that interns and residents might be making more mistakes than before. The latest study looked into 2,300 interns from over a dozen hospitals throughout the nation. The researchers compared interns before the 2011 regulations and interns after the new hours were set. They found that based off of self reports, the new hours did not equal more sleep. The rates of depression were still the same between both groups, which sat at 20 percent and the number of medical errors were actually higher than before.

"In a year before the new duty hour rules took effect, 19.9 percent of the interns reported committing an error that harmed a patient, but this percentage went up to 23.3 percent after the new rules went into effect," Dr. Srijan Sen, the study's author stated. Sen is a psychiatrist from the University of Michigan. "That's a 15 to 20 percent increase in errors - a pretty dramatic uptick, especially when you consider that part of the reason these work-hour rules were put into place was to reduce errors."

The study measured both groups at three, six, nine, and 12 months into the interns' first year as a resident. The factors that the researchers looked at included hours of sleep, on call hours, symptoms of depression, overall well-being, and the number of medical errors. The interns that worked before the new hours were implemented were on duty every fourth night and worked a maximum of 30 hours and the other group did not work over 16 hours per shift.

The cause of the medical errors cannot be pinpointed to one factor of course. The researchers observed the possible contributing factors and noted that although interns were working less, they were still expected to perform the same and accomplish the same amount of tasks as the interns who previously worked more. This increases the stress levels for newer interns to finish their work despite not being able to work as many hours as before.

"Though many programs have made some attempts to account for this lost work in other ways, the end result is that current interns have about 20 less hours each week to complete the same or only slightly less work. If we know that times tests result in more errors than untimed ones, we should not be surprised that giving interns less time to complete the same amount of work would increase their errors as well," Dr. Breck Nichols, another author of the study explained. Nichols is the program director of the combined Internal Medicine and Pediatrics residency program at the University of Southern California.

Furthermore, another possible factor is that interns do not have the chance to follow through on certain cases and once the cases get transferred over to another intern, more medical errors might arise due to the lack of information. This study reminds doctors and hospitals that hours alone cannot lower the number of errors. There are several factors that contribute to making interns better doctors, and understanding how these factors influence one another and the interns is important in attempting to prevent medical errors.

The study was published in JAMA Internal Medicine.

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