• 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."