Concern About Medical Errors Spurs Push to Reduce Resident Hours

Residents will be limited to an 80-hour workweek, with one day off in seven, and on call no longer than 24 continuous hours and no more often than every third night, under new requirements proposed by the Accreditation Council for Graduate Medical Education (ACGME) in June.

The requirements are scheduled to go into effect July 1, 2003. The American Medical Association (AMA) endorsed a nearly identical proposal at its annual meeting, also in June.

At the annual meeting of the Associated Professional Sleep Societies, held that same month, speakers summarized recommendations from a national conference on sleep loss and fatigue in medical training sponsored by the American Academy of Sleep Medicine (AASM), AMA, and other groups last October. Concerns that fatigue contributes to medical errors prompted that conference. The Institute of Medicine estimates that medical errors may cause as many as 98,000 deaths in the nation’s hospitals each year.

The ACGME proposal focuses not just on work hours but also on trying to ensure that residents are well rested. That is a key concern of the sleep community, said Judith Owens, M.D., M.P.H., of Hasbro Children’s Hospital in Providence, R.I., who chaired the AASM session. Regulation of work hours, she said, is necessary but not sufficient to achieve that goal.

The ACGME proposal, she noted, allows requirements for hours, days off, and call frequency to be averaged over four weeks. It also permits up to six additional hours after 24 hours on call to transfer care and for educational activities. These provisions, Owens said, are a potential source of at least occasional excessive hours and sleep disruption.

While ACGME expects to monitor compliance, Owens said, assessing outcomes may be even more important. Ideally, she said, residents will get enough sleep to perform at or near their best.

The ACGME’s proposed requirements are posted on the Web at www.acgme.org/new/ProgramDutyHours.pdf. ▪