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Medical Resident Work Restrictions and Patient Safety

medical resident restrictionsMedical resident doctors face a number of challenges. While their residency is an educational time, it's also a demanding time. Department rotations, attempting procedures for the first time, coordinating patient care between long shifts, and unpredictable work hours are just a few of these demands. A medical resident's personal time is often strapped. 

North Carolina is home to many teaching hospitals and residency programs. The University of North Carolina-Chapel Hill operates residencies in Chapel Hill and at New Hanover Regional Medical Center in Wilmington. Other programs include Duke University Hospital Program in Durham, Cone Health Program in Greensboro, Vidant Medical Center/East Carolina University in Greenville, and Wake Forest University School of Medicine Program in Winston-Salem, among others.

Medical residents must respond to work demands during their residency. This might require lost sleep, missed meals, and stressful work conditions. The risk of medical error is higher among overworked residents. Prescription errors, surgical mistakes, misdiagnoses, and other complications could compromise patient care. In the 1980s, a fatal medication error prompted an investigation and new mandates for resident work hours in the respective state where the incident occurred. The investigation found that the physician had made the error while working a 36-hour shift.

Almost two decades later, the Accreditation Council for Graduate Medical Education presented new resident work hour limitations on a nationwide scope, with some exemptions for certain practice areas. These limits imposed that:

 

  • Residents should have one day off weekly
  • Residents should not work more than 24 consecutive hours, and a maximum of 80 hours weekly
  • Residents should not be "on-call" more than every third night

 

Subsequent research showed that work restrictions reduced errors, particularly those in intensive care. However, a decade later, a study showed that resident work restrictions caused a drop in medical exam proficiency, had no effect on increasing sleep time, and did not improve rates of depression among residents.

Patient safety is not the only area that could be compromised due to an overworked resident. Physician safety is also a concern. A fatigued resident might fall asleep behind the wheel while commuting home, or hurt themselves while performing a medical procedure. As of this writing, the latest work restrictions also place requirements on the institution where the resident practices. One requirement states, "The sponsoring institution must provide adequate sleep facilities and/or safe
transportation options for residents who may be too fatigued to safely return home."

The regulations go into greater detail defining 'adequate sleep facilities' and further describe what encompasses a resident's 80-hour work week. These weeks are calculated on average over a 4-week window. A resident's on-duty time "includes inpatient and outpatient clinical care, in-house call, short call, night float and day float, transfer of patient care, and administrative activities related to patient care such as completing medical records, ordering and reviewing lab tests, and signing verbal orders." Also, any time spent on a hospital committee and interviewing residency candidates is also included. 

Log books and hospital records should monitor a resident's work hours. If a medical error occurs and a medical malpractice claim is presented, hospital records might help show that supervising staff failed to properly restrict a resident's hours. This is just one type of evidence that can be gathered in a malpractice case. Learn about an important North Carolina statute that should be reviewed for every potential malpractice claim.