48 Hours
RCS President John Black said: “Throughout this affair the call from the Department of Health has been that this legislation is about making patients safer.
“We now have a clear message from the front line that patient care is being made significantly less safe through systems that lead to poor continuity of care, the loss of teams and ‘wildcat’ closure of services.”
Protecting patients
He said trainee surgeons across the country were staying on unpaid after the hours limit because they wanted to see through care for patients.
And they were taking on additional paid locum work in the hope of gaining the training opportunities they could not get in their formal working week, he added.
This is a really interesting perspective. The Europeans have a 48 hour cap on resident work hours. 48 hours! That would mean that the average European resident would have to extend their training by 62% to get in the same amount of time in front of patients as a U.S. trained resident physician. And I thought training was long enough as it is! We have a similar law in the US, albeit with a higher hourly limit.
The U.S. implemented a law in recent years limiting resident work hours to 80 hours per week. The argument being that less hours equals more well rested residents equals better patient safety. The nationwide law stems from a case that occured at New York Hospital Cornell Medical Center (now NY Presbyterian). It is intended to protect residents and patients- although some say that whether it actually does this is arguable. One thing is clear: that while, residents are more rested than they used to be, there are clearly more “hand offs” of patient care. This presents its own unique set of problems: (can’t help but use a football analogy here but) the more times you hand off the ball the more times there is a chance for a fumble. The evidence shows that perhaps 2/3or more of clinical errors are precipitated by poor communication. We trade a system with one particular risk- sleep deprived practitioners- for another- increased information transfers. Oy.
Nobody I know is a fan of working 100+ hours per week- if they tell you this they are lying or psychotic..OK some surgeons are psychotic. But I can say from personal experience as a resident that I definitely liked managing one service of patients, for 80+ hours per week rather than doing 50 hours per week of shift work. I did both. And for me, the shift work was more stressful. When I was responsible for one service and in house all of the time, I knew every patient well. And a problem could usually be fixed with a quick adjustment. Nightfloat shifts, on the other hand, were torture. It was an exercise in putting out fires on patients you didn’t know well and everything always seemed to take twice as long as normal.
I am not advocating going back to 100+ hour work weeks. They are ludicrous with the level of complexity of most inpatients these days. But we do need solutions for better transfers of patient information.
