Surgeons still tired despite duty hour limits

Fatigued residents have a 22 percent greater risk of causing a medical error than alert, well-rested doctors, according to a study published in the Archives of Surgery, Reuters Health reported.

Researchers studied orthopedic surgical residents at Massachusetts General Hospital and Brigham and Women's Hospital and found that the 27 participating residents clocked an average of 5.3 hours of sleep a day, ranging from 2.8 hours to 7.2 hours.

"Fatigue was higher than we expected," Frank McCormick from the Harvard Combined Orthopaedic Residency Program and Massachusetts General Hospital told Reuters Health.

Surgeons were tired half of their waking hours, operating on less than 80 percent mental effectiveness, according to the study. What's more, a quarter of the time their fatigue was tantamount to being legally drunk at less than 70% mental effectiveness (correlating with a blood alcohol level of 0.08%).

Considering the threat that fatiqued residents pose to patient safety, the Accreditation Council for Graduate Medical Education last year enacted duty hour rules, stating that first-year residents must not work more than 16 consecutive hours.

Although the study data isn't entirely new, it does point to patient safety risks even under new duty hour limits.

"Their actual determination of fatigue during certain periods is not startling, but its pervasiveness is a finding we simply cannot avoid and may have paid lip service to in the past," Thomas F. Tracy Jr., of Hasbro Children's Hospital and Brown University in Providence wrote in an accompanying editorial.

"We have made things worse by our attempt to fill mandates of prescribed work hours on the basis of activities external to healthcare delivery systems" he added. "If we are really serious about this, it may be time to debate work hours and methods in training centers to mitigate patient error with the inclusion of these measurements to adequately design shift configuration."

For more information:
- read the study
- see the Reuters Health article
- here's the research announcement

Related Articles:
Sleepy surgeons can't handle surprises
Long work hours linked to adverse events, Joint Commission warns
Teamwork among fatigued providers could boost patient safety
July effect: New interns 'perfect storm' for higher mortality rates
New resident duty-hour limits not enough: Fatigue, errors still rampant