Experts call for major overhaul of hospital residency care programs

June 27, 2011

A group of 26 health experts on Friday called for major changes to U.S. hospital residency care programs to protect patients from preventable errors and prohibit dangerously long shifts for training physicians.

Last year, the Accreditation Council for Graduate Medical Education (ACGME) released updated common program requirements for residency programs, including a maximum shift limit of 16 hours for post-graduate year one residents. However, the requirements allow more senior residents to work for 28 consecutive hours. Those changes are expected to go into effect on July 1.

Twenty-six health leaders from myriad organizations—including the Agency for Healthcare Research and Quality, the American Hospital Association, the Joint Commission, Brigham and Women's Hospital, and Harvard School of Public Health—wrote in Nature and Science of Sleep that the new requirements "stop considerably short" of best practices for patient safety.

At a Harvard Medical School conference last year, the group developed a road map for implementation of the Institute of Medicine's (IOM) residency reform recommendations. Those recommendations include:

  • Restricting resident work hours to 12- to 16-hour shifts;
  • Making compliance with ACGME work hours a requirement for receiving Medicare graduate medical education support;
  • Identifying when resident workloads become excessive and ensuring that additional staff is activated;
  • Requiring attending physicians to supersize admissions;
  • Requiring supervision for critical care services; and
  • Establishing fatigue management as a Joint Commission National Patient Safety Goal.

"The current system amounts to an abuse of patient trust," according to one of the report's authors, who notes that "few people enter a hospital expecting that their care and safety are in the hands of someone who has been working a double-shift or more with no sleep."

The experts also recommended that residency programs:

  • Redesign resident workload requirements to improve education;
  • Provide transportation for residents who are too exhausted to safely drive home; and
  • Include moonlighting in shift hour limits (Harvard conference group release, 6/24; Seaman, Reuters, 6/24).