Long work shifts continue to be a problem for interns

AORN Journal, Oct, 2006

Two recent studies show that long work shifts continue to be an issue for first-year medical residents (ie, interns), according to a Sept 6, 2006, news release from the Agency for Healthcare Research and Quality. One study found that although national standards implemented by the medical profession in 2003 limit the number of hours a medical intern may work, nearly 84% of medical interns reported that they are continuing to work hours that exceed these limits. Research has shown that sleep-deprived medical interns who work traditional 24-hour shifts make many more serious medical errors and are involved in car accidents more often than those whose work is limited to 16 consecutive hours.

The standards, introduced by the Accreditation Council for Graduate Medical Education (ACGME),

* Limits medical interns to a maximum of 30 consecutive work hours,

* prohibits them from working more than 80 hours per week averaged over four weeks, and

* mandates that they must be free of all duties for one day in seven.

Even these limits are far beyond established safe limits for pilots and truck drivers, and the limits for physicians in Europe are set by law at no more than 13 consecutive work hours.

Data from mandatory reports submitted to the ACGME one year after implementation of the standards indicated that only 5% of residency programs did not comply with the limitations; however, an independent, nationwide study found that 83.6% of medical interns reported work hours that did not comply with the standards. According to the researchers, reasons for noncompliance with the standards may be a result of

* financial or technical difficulties in redesigning the program to comply with the standards or

* the culture within particular medical institutions, in which some senior physicians may express disapproval of work-hour limits or may not believe that fatigue can be a threat to patient safety.

A second, related study found that medical interns reported 61% more needle sticks and sharps injuries during the day after an overnight shift than during a day that was preceded by a night at home. In addition, medical interns experienced more than twice the rate of sharps injuries during the night than during the day. The two most commonly reported contributing factors were lapses in concentration (ie, 64%) and fatigue (ie, 31%).

National Study of Medical Interns Finds Majority Exceed Work Hour Limits; Link Made Between Needle Stick Injuries and Long Shifts (news release, Rockville, Md: Agency for Healthcare Research and Quality, Sept 6, 2006).