I’ve blogged about limiting residents’ workloads in the past, and now a major US hospital is in trouble for violating the five-year-old limits. Massachusetts General Hospital, a teaching hospital of Harvard Medical School, has been cited by the Accreditation Council for Graduate Medical Education for having a number of residents working unacceptably long hours. The rules cap residents’ work to 80 hours per week and allow for up to 30 hours work in one stretch, whereas in the past it wasn’t unusual for residents to work more like 120 hours per week.
Some hospitals have been reluctant to adopt the new rules because they feel limiting residents’ workloads will lead to more handoffs, and thus more errors. Additionally, they worry that residents won’t be able to learn properly if their hours are cut back severely. Five to ten percent of surgery programs were cited last year by the council, indicating that compliance is still a problem. Now, the Institute of Medicine is calling for decreasing workloads even further.
How effective the rules have been is still up for debate. One study showed that fatigue is down among residents, but there were no significant improvements in patient care. Adapting to the new rules has not been a totally smooth process, as evidenced by the Harvard hospital and others who have been cited. Before the Institute of Medicine asks for tighter rules, it should first be determined whether patient outcomes are really improving, and whether the learning process for residents has been effected.
Read about the citing of the hospital in the Wall Street Journal and the Boston Globe.
