The New Duty Hour Rules - A step forward or two steps back?

by Joelle N. Simpson MD, MPH (CNMC)

Article #1: The Effects of the 2011 Duty Hour Reforms on Interns and Their Patients

Article #2: Effect of the 2011 vs 2003 Duty Hour Regulation–Compliant Models on Sleep Duration, Trainee Education, and Continuity of Patient Care Among Internal Medicine House Staff

This week's articles are from JAMA's recent e-publication which presents data demonstrating the impact of the shortened work-hours mandated by the ACGME – the overall conclusions are that these new rules may be doing more harm than good.

The first study shows that despite the decrease in duty hours, there were no significant changes in hours slept, depressive symptoms or well-being score reported by interns but increased self-reporting of medical errors.

The second study based at Hopkins shows that while the regulations produced increased sleep duration during the on-call period, they also decreased continuity of patient care, intern and nurse perceptions of quality of care, and educational opportunities from teaching and patient care. The conclusions suggest increased supervision and training in handoffs to mitigate these issues.

This is a nice opportunity to plug the work that Priya has been doing around handoffs in the Emergency Department. While we are not directly affected in the same way as our inpatient colleagues regarding work hours since we are mostly shift work, we are obviously experienced in these issues of safety in patient handoffs. 

A quote from the Hopkins paper summarizes nicely: “The increase in handoffs may be a contributing factor to the increase in self-reported medical errors with the implementation of the new duty hour. While curricula in handoff training for residents have remained largely undeveloped, initial studies of standardized handoff systems have been effective in reducing errors.”  I totally agree, there is a science and art to handoffs that should be taught. Our use of the SOUND mnemonic is a start but we should be emphasizing the teaching points of safe handoffs to trainees for the safety of our patients.