Thanks for your interesting anecdote, Argent; you aren’t alone, as you now know more clearly than when you were 26. Glad to have your inputs here at HW/PC.
Flight takeoffs and landings are an interesting parallel to the subtopic being discussed here. The majority of student flight accidents occur during these transition phases (look it up). Planes don’t generally just fall out of the air mid-flight; the majority fatal “crashes” commonly occur when the “handoffs” take place between earth and sky.
In hospitals, ineffective handoffs of information, responsibility and accountability similarly are a key source of patient safety “crashes.” Accordingly, each and every hospital has developed their own unique internal procedures—systems engineering methods—to help minimize handoff problems. Dr Atul Gawande
(some of you may be familiar with him as author of “Being Mortal”) wrote two acclaimed, best-selling books related to this topic: “Complications: A Surgeon's Notes on an Imperfect Science” and “Better: A Surgeon's Notes on Performance” which emphasizes the systems approach to hospital error reduction without wiping out individual conscientiousness.
In flight, just about
everyone uses essentially the same checklist prior to takeoffs and landings…but each flight has exactly one takeoff and one landing. A flight from Chicago to Cleveland has one of each, and so does the flight from Chicago to Tokyo. In hospitals, just about
every individual hospital has their own, unique (different) handoff procedure. Quite naturally there is variation and some hospitals are better than others at handoffs. HERE’S A KEY POINT: when there are shorter duty cycles/shifts of workers, patients experience more handoffs
(more takeoffs & landings), and (therefore) more problems occur
Sleep deprivation is also source of hospital errors; there is no dispute about
this fact, and I think several members posted links (I didn't read them; no need) which are probably informative about
the existence of cognitive performance impairment from lack of sleep. Probably some of those studies were used a decade ago when the maximum duty of residents was reduced from 24- to 16-hours, believing
that with more sleep fewer mistakes would be made.
Does the reduction in duty cycle/sleep deprivation improve patient mortality outcomes? It turns out “no.” Following the recent increase back
to 24-hours max duty cycle, sixty-three internal medicine residency programs participated (coordinated out of UPenn) in a study published in March 2019 in the NEJM (look it up)—half of first-year residents were restricted to 16-hours shifts, the other half had no limit on how long residents could work. Results: the number of patients who died within 30 days was statistically the same, and although medical errors were not directly examined, the implication is that the rate of medical error was also similar.
So, bottom line: the shorter duty cycles don’t reduce mortality/errors in terms of sleep deprivation, but shorter duty cycles create more risky “handoffs.”
In the OP, this was posted:
Let's hear it if you have an opinion on this practice [24-hour resident duty], agreeing or disagreeing with it.
My opinion--counter-intuitive as it may be to some of you--is based on these data.
Post Edited (Blackjack) : 6/12/2019 11:06:34 AM (GMT-6)