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IOM proposes resident sleep hour changes: What it means for hospital medicine

Hospitalist Leadership Connection, December 16, 2008

The Institute of Medicine (IOM) proposed revisions to medical residents sleep hours to reduce fatigue-related medical errors, in a report “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety,” released this month. If enacted, the changes would require teaching hospitals to dedicate an additional $1.7 billion each year to shift the workload to other healthcare staff or additional residents, according to a Dec. 2 National Academies press release.

The IOM recommends maintaining the current duty-hour limits of 80 hours per week (averaged over four weeks), as dictated by the Accreditation Council for Graduate Medical Education (ACGME) since 2003.

However, in 2007, the IOM Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Patient Safety, which evaluated schedules and handoffs, found that the current standard of 30 consecutive awake hours can lead to fatigue, which can negatively affect patient care.

The proposed IOM changes consequently call for extended shifts while maintaining the 80-hour averaged work week. Instead of 30 consecutive awake hours, residents would either 1) work a maximum of 16 continuous hours with no protected sleep time, or 2) work a 30-hour shift, starting with 16 consecutive awake hours, 5 hours protected sleep time, and remaining hours for transition and educational activities.

The proposal also calls for defined off-duty periods between shifts, more resident days off, and restricted moonlighting during residents’ off-hours. In addition, the committee suggests scheduling shift changeovers: overlapping residents’ shift changes with other teams, for more effective handoffs.

"Healthcare facilities can create safer conditions within the existing 80-hour limit by providing residents regular opportunities for sleep and limiting extended periods of work without rest,” said committee chair Michael M.E. Johns, chancellor, Emory University, Atlanta, in the press release. “But these steps should be supplemented by additional efforts to improve patient safety and ensure residents get the full experience they need to safely and competently practice medicine at the end of their training."

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