Study Finds Increased Incidence of Preventable Errors Following Extended Shifts 

Barger et al. “Impact of extended-duration shifts on medical errors, adverse events, and attentional failures.” Public Library of Science Medicine, Dec. 2006 3(12). (Download in PDF.) 

A study published  in the December 2006 issue of Public Library of Science Medicine reveals that medical interns who in one month work five or more shifts of 24 consecutive hours or more increase their risk of making a fatigue-related mistake that harms a patient by 700 percent. And, reports one of the study’s authors, Charles Czeisler, MD, PhD, “their risk of making a fatigue-related preventable adverse event that results in the death of a patient is increased by 300 percent.”

According to the study’s methodology, the interns themselves, not their physician supervisors, recognized and reported the occurrence of errors. The study’s authors note that “the perception of having made a medical error that causes an adverse patient outcome creates significant emotional distress for physicians that can last days or years,” and that “the personal distress and reduced empathy associated with perceived medical errors increase the odds of future medical errors.”

This recent research, completed by a team of doctors and scientists at the Harvard Work Hours, Health, and Safety Study Group, is the latest in a growing body of scientific evidence that highlights the ill effects of excessive resident work hours. The researchers at Harvard have previously published studies reporting that long work hours increased the likelihood of residents injuring themselves in needle stick accidents and more than doubled the rate if resident physician car accidents.

Yet despite this mounting evidence, the current regulations of the Accreditation Council for Graduate Medical Education (ACGME), the body responsible for overseeing resident physician training in the US, allow residents to be scheduled for 30-hour shifts every third night. This failure of the ACGME to change its scheduling policies to prevent against fatigue-related impairment has prompted a growing chorus of voices calling for federal legislation reducing resident work hours.

“This study is an important contribution to the already overwhelming scientific evidence that links excessive work hours, fatigue and medical errors – evidence that the accrediting body that oversees training for the country’s 100,000+ resident physicians continues to ignore. We need legislation to limit resident work hours and we need it now,” said Dr. Simon Ahtaridis, President of the Committee of Interns and Residents/SEIU, the nation’s largest union of resident physicians.

“We have regulation for the airlines and other industries that are entrusted with the public’s safety,” said Dr. Ahtaridis. “Why should medicine be any different?”         

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Click here to read the full study, “Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attentional Failures,” Public Library of Science Medicine , December 2006 in PDF format.  

Read news coverage of the study in USA Today.

Listen to a segment about the study from National Public Radio’s Morning Edition.

Visit the Harvard Work Hours, Health, and Safety Study Group Website.