Patient Safety Threatened by Effort to Weaken Resident Hour Limits: Group

The prominent consumer interest group Public Citizen is calling on a medical education association to back off from its proposed revision to rules designed to reduce the number of consecutive hours physician residents can work. 

In a statement issued March 15, Public Citizen warns that patient safety will be compromised by the efforts of the Accreditation Council for Graduate Medical Education (ACGME), which plans to convene an invitation-only meeting this week to discuss resident duty hours that would revise current rules established in 2011 that cap resident working hours.

In 2011, the ACGME mandated a 16-consecutive hour cap on shifts for first year residents, a 28 hour cap on shifts for all other residents, and a minimum 8 hour time off between work shifts for all residents. The rules were put in place to protect patients and reduce the risk of medical mistakes caused by fatigue, which have been shown to be 10 times more prevalent than previously believed.

Multiple physician groups have lobbied against these regulations, calling for a rollback of elements of ACGME restrictions. These critics say limits may actually increase the rate of medical errors, by increasing the frequency of patient handoffs between medical residents.

“There is no valid evidence from well-designed studies to support these assertions,” said Dr. Michael Carome, Director of Public Citizen’s Health Research Group, in the statement urging the group not to weaken the current rules.

In 2014, a study concluded patient handoff errors can be addressed using the I-PASS program, which researchers found reduced can reduce the risk of serious and potentially life-threatening medical errors by 23% and injuries due to medical errors by 30%, while improving patient care.

Public Citizen argues physician weakening resident work hour restrictions may lead to residents working without adequate sleep and threaten the health of residents and patients. The group cites evidence that shows sleep deprivation, due to excessively long work shifts, increases the risk of motor vehicle accidents, depression, needle-stick and other injuries that expose residents to blood-borne pathogens. It also exposes patients to increased risk of medical errors, leading to injury and death.

The only rigorous trial to date concludes reducing shifts to 16 hours or less helped to reduce the frequency of serious medical errors, the group says.

The ACGME provided funding for two clinical trials designed to compare the death and injury rates among patients treated by two groups of randomly assigned first-year residents. One group of residents worked shifts with limit hours, and the other was allowed to work longer than 28 or more hours. The clinical trial was heavily criticized, since it forced many residents to work dangerously long hours.

In the Public Citizen statement, Carome indicated that studies supporting longer resident work hours are “biased and designed poorly,” focusing on research that creates evidence to support lifting protective limits.

Public Citizen calls on ACGME to strengthen patient and resident safety by expanding the limits to a 16 hour cap for first year residents and implementing standards for better patient handoff.