More Sleep for Doctors in Training Shows More Medical Errors in Practice

These days, doctors are having a bit of trouble diagnosing a new problem. They thought giving residents less time on duty to catch up on some much needed rest might result in less medical errors. However, recent research shows that this isn't quite the case. But why?

According to Time, since 2011, new regulations restricting the number of continuous hours first-year residents spend on call cut the time that trainees spend at the hospital during a typical duty session from 24 hours to 16 hours. Excessively long shifts, studies showed, were leading to fatigue and stress that hampered not just the learning process, but the care these doctors provided to patients.

In 1987, a New York State commission limited the number of hours that doctors could train in the hospital to 80 each week, which was less than the 100-hour-a-week shifts with 36-hour call times that were the norm at the time. In 2003, the Accreditation Council for Graduate Medical Education followed suit with rules for all programs that mandated that trainees could work no more than 24 consecutive hours.

As the hours were cut even further in 2011, the latest data published in the journal Jama Internal Medicine shows that interns working under the new rules are reporting more mistakes, not enough sleep and symptoms of depression.

In the study that involved 2,300 doctors from more than a dozen national hospitals, the researchers compared a population of interns serving before the 2011 work-hour limit was implemented, with interns working after the new rule, during a three-month period. Those in the former group were on call every fourth night, for a maximum of 30 hours, while the latter group worked no more than 16 hours during any one shift. They gathered self-reported data from on their duty hours, sleep hours, symptoms of depression, well-being and medical errors at three, six, nine and 12 months into their first year of residency.

Although the trainees working under the current work rules spent fewer hours at the hospital, they were not sleeping more on average than residents did prior to the rule change, and their risk of depression remained the same, at 20 percent, as it was among the doctors working prior to 2011. And the number of medical errors the post-2011 doctors reported was higher than that documented among previous trainees.

"In the 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," said study author Dr. Srijan Sen, a University of Michiganpsychiatrist in a statement. "That's a 15 percent 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."

How could fewer hours lead to more errors? For one, interns reported that while they weren't working as many hours, they were still expected to accomplish the same amount that previous classes had, so they had less time to complete their duties. In addition, they also had less time to complete those duties.