Resident Physician Work Hours – Association with Harm and Occupational Injury

May 12, 2023

Written by Doug Wallace

Spoon Feed
Working extended duration shifts (≥ 24 hours) and > 48 hours/week were associated with an increased risk of medical errors, adverse events, MVAs, occupational exposures, percutaneous injuries, and attentional failures regardless of experience level in a large nationwide prospective cohort study.

Why does this matter?
Resident work hours and shift duration have been the subject of multiple studies and Spoon Feeds (Resident Duty Hours, FIRST, iCOMPARE, ICU Resident, Resident Schedule), with mixed results. Current ACGME policy allows for 28-hour shifts and 80 to 88-hour work weeks.

Extended work hours may increase harm among trainees, regardless of level of training
The referenced study was a nationwide prospective cohort study that surveyed resident physicians from multiple specialties and years of training over a cumulative 8 year period with 38,702 self-reported surveys analyzed. 

Key findings were that, regardless of experience level, the incidence of medical errors, adverse events, MVAs, occupational exposures, percutaneous injuries, and attentional failures correlated with increased work hours in a linear fashion.

Potential limitations include participation bias and self-reported data.

The authors state, “that the current ACGME work hour guidelines could pose considerable hazards to patients and resident physicians,” and go on to suggest that further work hour restrictions may reduce risk of harm for resident physicians and patients. 

My takeaways: My gestalt and anecdotal experience suggest working long hours without adequate sleep and excessive work hours are likely detrimental to clinician health and patient care delivery. This study provides well designed empirical support for this assertion. This is an interesting article that may prompt landmark regulatory changes surrounding resident work hours and is more than worth a read. 

Source
Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study. BMJ Medicine 2023;2:e000320. doi: 10.1136/bmjmed-2022-000320