Experts call for lighter resident workload to protect patients

New rules on residency training that take effect July 1 "stop considerably short" of guaranteeing the patient safety, healthcare experts argue in a new article that calls for shorter hours for residents.

The 26 experts say residents should not work more than 16 hours without sleep and recommend tying Medicare training funds to work-hour compliance. The recommendations are detailed in the latest issue of the online journal Nature & Science of Sleep.

"The current system amounts to an abuse of patient trust," report co-author Lucian Leape said in a statement. "Few people enter a hospital expecting that their care and safety are in the hands of someone who has been working a double-shift or more with no sleep. If they knew, and had a choice, the overwhelming majority would demand another doctor or leave."

• Limiting all resident physician work hours to shifts of 12 to 16 hours;

• Making work-hour compliance a condition for getting Medicare graduate medical education (GME) dollars;

• Identifying in real time when a resident physician's workload is excessive and additional staff should be activated;

• Requiring attending physicians to supervise all hospital admissions;

• Mandating in-house supervision for all critical care services, including emergency, intensive care and trauma services; and 

• Making comprehensive fatigue management a Joint Commission National Patient Safety Goal. 

The recommendations go on to note that "fatigue is a safety concern not only for resident physicians, but for nurses, attending physicians and other healthcare workers."