Medical Residents and Safety

Listening to an article on Morning Edition this week, Is It Safe for Medical Residents to Work 30-Hour Shifts? A study has begun randomly putting some residents in 30 hour shifts and others in 16 hour shifts to see if there is a difference the proportion of patients who die within 30 days (can’t believe I’m writing that, but the outcome being measured is 30 day mortality, really). In 2003 a law was passed limiting residents to 16 hour shift maximums. Hospitals want to go back to 30 hour shifts because the 16 hour shifts are more expensive. A concern is that 30 hours is too long and dangerous.  As a young emergency and intensive care nurse I found 12 hours to be my limit.

The story discusses two issues: 1) hand-offs from resident to resident – updating the next shift about patient status.  More frequent if shifts are shorter. More hand-offs, more chance for error. Not discussed  is the role of nursing. Residents, young, inexperienced doctors, see patients infrequently each shift (more often if the patient is sicker).  It’s usually the nurse that is expert about the patient and family and about the procedures and treatments.  Nurses know what’s going on. Nurses have to be alert and helpful and share what they know – residents, especially early in their rotations are less experienced. Residents often don’t know how to collaborate with nurses and may not appreciate them. Tired student doctors are harder for nurses to work with and require more alertness.  2) Neither patients nor residents give consent in this study. Residents are assigned a shift length and have to work it. The Hastings Center for Bioethics says this is ethical. The article has residents complaining about the lack of consent.  What about the patients? It’s too much work, too complex to figure out how to get all the patients’ consent.  What does that tell you? It confirms for me that you need to take people to the hospital with you and bond with your nurses.

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