People make mistakes when they get tired. Fatigue is a known safety hazard in many industries. One of the reasons for establishing the 40-hour work week was to cut down on the number of fatal workplace accidents. The Fair Labor Standards Act codified this limitation on working hours in 1938 as part of Franklin Roosevelt’s New Deal. The FLSA was a step forward for workers, but not every job was included in its protections. Salaried employees and professionals do not qualify for overtime pay and are often expected to work more than 40 hours in a week. In fact, according to a Gallup survey, the average work week for full-time employees is 47 hours. For medical residents, 40 hours is an unusually long shift.
Fatigue Affects Everyone
Being a professional does not shield you from the effects of fatigue. In the medical field, mistakes can have life or death consequences. Asking medical residents to work 24 to 36 hour shifts was a relatively routine, but highly questionable practice. The Centers for Disease Control and Prevention reports that the period from the 9th to 12th hours in a long work day is marked by decreased alertness, increased fatigue, reduced cognitive function and decreasing vigilance in completing tasks correctly. All of these conditions increased the chances of a medical mistake based on negligence.
What Has Been Done?
In 2011, the Accreditation Council for Graduate Medical Education decided to limit residents to an 80-hour work week. First-year residents could only be scheduled for 16-hour shifts. Second-year residents were allowed 24-hour shifts. The restrictions could be “eased” allowing for a 30-hour shift if it was in service to the goals of continuity of care and learning for the resident. Five years later, some critics are looking to roll back even these minimal restrictions. The returns have been uncertain, and some people are arguing that curbing fatigue isn’t worth the disruption to medical tradition.
Where Things Go Wrong
Part of the problem is that many medical errors happen when a person’s care is handed off from one physician or team to another. Handoffs see key information lost and important signs missed. One argument to allow residents to work well past the point of fatigue is that it reduces the number of these handoffs. A better argument would be to improve handoff procedures and make sure the resident doing the handing off isn’t doing so in an advanced state of exhaustion. Medical mistakes are inevitable as long as medical care providers are allowed to work while fatigued. Shift hours should be kept sufficiently short to allow residents time to sleep and recharge. This would help reduce medical malpractice and could also improve the longstanding issues of burnout and depression that have plagued the medical community.
Source: STAT, “Working to exhaustion: How medical residents’ long shifts put patients at risk,” by Tejal K. Gandhi and Patricia A. McGaffigan, 8 June 2016