Sleep deprivation at teaching hospitals

Sleep-Deprivation Studies Fail to Wake up Teaching Hospitals

Exhausted people make more mistakes than those who’ve had a good night’s sleep. “Duh!” as teenagers might say. Yet as obvious as that reasoning seems, hospitals aren’t buying it. Despite horror stories about errors committed by bleary-eyed residents, thousands of doctors in training regularly work shifts of 30 consecutive hours a few times a month.

Medical educators, of all people, should know how dangerous that is. Going 24 hours without sleep is comparable to having a blood alcohol level of .10, which meets or exceeds every state’s standard for being legally drunk, a 2005 study in the Journal of the American Medical Association (JAMA) found.

Not surprisingly, sleep-deprived doctors are at high risk of making mistakes that injure or kill patients. When residents reported working five marathon shifts in a single month, their risk of making a fatigue-related mistake that harmed a patient is increased by 700%, and the risk of an error that resulted in a patient’s death shot up 300%, according to a study published last week in the journal Public Library of Science Medicine.

These new findings echo older studies that found overworked interns are more likely to make mistakes, such as sticking a tube in the wrong vein or ordering 10 times the correct dosage of a medication. What’s distressing is that so little progress has been made.

Since 2003, the Accreditation Council for Graduate Medical Education has limited residents’ hours to 80 a week and no more than 30 consecutive hours per shift. Although the ACGME claims that its rules are being obeyed by teaching hospitals and that only 2% of residents reported working more than 80 hours a week last year, others strongly disagree. In the first year since the rules took effect, 67% of interns (first-year residents) reported working more than 30-hour shifts, and 43% said they worked more than 80 hours a week, a September JAMA study found.

The bigger barrier to reform is cost. Cutting residents’ hours to meet ACGME guidelines would require either more doctors or less care. But in the long run it would save lives and avoid expensive malpractice lawsuits. Additional concerns about continuity of care also have some merit, as vital information can fall through cracks when a physician hands off a patient to a colleague.

Nevertheless, it’s unrealistic to expect that young doctors who can’t keep their eyes open while speaking to patients, attending classes or even assisting in surgery will make the best decisions about treating patients. Sleep is a biological necessity, even for doctors. It’s time their teachers grasped that lesson.