The Accreditation Council for Graduate Medical Education (ACGME) has mandated limits to first year residents (interns) to 16-hour shifts, as of the end of this June. The purpose is to mitigate medical errors caused by sleep deprivation. Still, critics believe other unintended consequences may raise the abundance of error.
The 16-hour shift stands for first-year residents. Second- and third-year residents are limited to 28-hour shifts and cannot take new patients after the first 24 hours. The national cost for these rules is estimated at $381 million per year.
A clear negative consequence of this new rule is to increase the incidence of handoffs: when one medical professional ends a shift and gives the patient to another medical staffer. Much is often lost during handoff communications, and hospitals are already implementing strategies to alleviate this issue.
Many graduate medical programs have already made plans in advance to adhere to the rules. To prepare for a thinner staff due to shorter hours, some schools have already hired "physician extenders" to fill in for the missing time. Schools have also set up mechanisms to monitor adherence to the new regulation and to test the effectiveness of the strategy for patients.
This is the second time the ACGME has mandated hours regulations within a decade. The last time was in 2003, when they instituted an 80-hour per week cap for residents.
Many of these restrictions arose from the Libby Zion case years ago in New York. It involved a young woman who was seen in the emergency room at a hospital here in Manhattan. She had overdosed and ultimately died at the hospital. Their attorney, Tom Moore of Kramer Diloff Tessel Duffy & Moore (the firm name has since changed to Kramer Livingston & Moore) argued that the residents who cared for Libby Zion were overworked because of their ragged and endless hours spent at the hospital continuously.
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