Do Hospital Work Limits Hurt Patients?

Feb. 14, 2005 — -- Racquel Daley-Placide, an internal medicine resident, loved staying up with hospital patients throughout the night and caring for them the following day.

"I enjoyed it," said the resident at the University of Oklahoma College of Medicine-Tulsa.

But recently passed regulations have limited residents' weekly duties to 80 hours. And some in the medical field are now questioning the benefit of those reduced hours.

"I was kind of upset about the rule, because I felt like that's what I was there to do," said Daley-Placide. However, she concedes the biggest advantage of the new system is the opportunity to spend time with her 2-year-old daughter.

Her husband, Jon, is a resident in a nearby program. "If Jon's program didn't also follow the 80-hour week, I don't think we could take care of Ashley. We'd probably have to send her to our parents," she said.

The standards, implemented in 2003 by the Accreditation Council for Graduate Medical Education, reduce residents' availability for hospital duty. The standards were a response to mounting concern among the public, medical professionals and consumer advocates that residents' long work hours were a threat to patient care.

An October 2004 study in the New England Journal of Medicine found that residents in their first year of training made one-third more serious mistakes during 30-hour shifts than they did in 16-hour periods.

And in January of this year, a study in the same journal found that first-year residents were more than twice as likely to be involved in car accidents after working 24 hours or longer, compared with those working shorter shifts.

"It's completely crazy to schedule people for sleep deprivation and chronic fatigue," said Bertrand Bell, who led a commission that designed New York state's legislation on residency work hours.

The Bell Commission reviewed the grand jury report regarding the accidental death of teenager Libby Zion at New York Hospital, in which the physical exhaustion of a resident was a contributing factor.