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Making Residency Work Hour Rules Work

Published online by Cambridge University Press:  01 January 2021

I. Glenn Cohen ,
Charles A. Czeisler  and
Christopher P. Landrigan
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Extract

Over the past decade, a series of studies have found that physicians-in-training who work extended shifts (>16 hours) are at increased risk of experiencing motor vehicle crashes, needlestick injuries, and medical errors. In response to public concerns and a request from Congress, the Institute of Medicine (IOM) conducted an inquiry into the issue and concluded in 2009 that resident physicians should not work for more than 16 consecutive hours without sleep. They further recommended that the Centers for Medicare & Medicaid Services (CMS) and the Joint Commission work with the Accreditation Council for Graduate Medical Education (ACGME) to ensure effective enforcement of new work hour standards.

The IOM's concerns with enforcement stem from well-documented non-compliance with the ACGME's 2003 work hour rules, and the ACGME's history of non-enforcement. In a nationwide cohort study, 84% of interns were found to violate the ACGME's 2003 standards in the year following their introduction.

Type
Independent
Information
Journal of Law, Medicine & Ethics , Volume 41 , Issue 1 , Spring 2013 , pp. 310 - 314
Copyright
Copyright © American Society of Law, Medicine and Ethics 2013

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References

Landrigan, C. P. Rothschild, J.M. Cronin, J. W. Kaushal, R. Burdick, E. Katz, J. T. et al. “Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units,” N Engl J Med 351, no. 18 (2004): 1838–1848; Lockley, S. W. Landrigan, C. P. Barger, L. K. Czeisler, C. A., “When Policy Meets Physiology: The Challenge of Reducing Resident Work Hours,” Clinical Orthopaedics and Related Research 449 (2006): 116–1127; Barger, L. K. Cade, B. E. Ayas, N. T. Cronin, J. W. Rosner, B. Speizer, F. E. et al., “Extended Work Shifts and the Risk of Motor Vehicle Crashes Among Interns,” New England Journal of Medicine 352, no. 2 (2005): 125–134; Ayas, N. T. Barger, L. K. Cade, B. E. Hashimoto, D. M. Rosner, B. Cronin, J. W. et al., “Extended Work Duration and the Risk of Self-reported Percutaneous Injuries in Interns,” JAMA 296, no. 9 (2006): 1055–1062; Philibert, I., “Sleep Loss and Performance in Residents and Non-Physicians: A Meta-Analytic Examination,” Sleep 28, no. 11 (2005): 1392–1402; Arnedt, J. T. Owens, J. Crouch, M. Stahl, J. Carskadon, M. A., “Neurobehavioral Performance of Residents After Heavy Night Call vs. After Alcohol Ingestion,” JAMA 294, no. 9 (2005): 1025–1033; Horwitz, L. I. Kosiborod, M. Lin, Z., and Krumholz, H. M., “Changes in Outcomes for Internal Medicine Inpatients After Work-Hour Regulations,” Annals of Internal Medicine 147, no. 2 (2007): 97–103; Barger, L. K. Ayas, N. T. Cade, B. E. Cronin, J. W. Rosner, B. Speizer, F. E. et al. “Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attentional Failures,” PLoS Med 3, no. 12 (2006): E487; Levine, A. C. Adusumilli, J., and Landrigan, C. P., “Effects of Reducing or Eliminating Resident Work Shifts over 16 Hours: A Systematic Review,” Sleep 33, no. 8 (2010): 1043–1053; Reed, D. A. Fletcher, K. E. Arora, V. M., “Systematic Review: Association of Shift Length, Protected Sleep Time, and Night Float with Patient Care, Residents' Health, and Education,” Annals of Internal Medicine 153, no. 12 (2010): 829–842.Google Scholar
Institute of Medicine, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety (Washington, D.C.: National Academies Press, 2009).Google Scholar
Landrigan, C. P. Barger, L. K. Cade, B. E. Ayas, N. T. Czeisler, C. A., “Interns' Compliance with Accreditation Council for Graduate Medical Education Work-Hour Limits,” JAMA 296, no. 9 (2006): 1063–1070.Google Scholar
Sticca, R. P. Macgregor, J. M., and Szlabick, R. E., “Is the Accreditation Council for Graduate Medical Education (ACGME) Resident/Fellow Survey, A Valid Tool to Assess General Surgery Residency Programs Compliance with Work Hours Regulations?” Journal of Surgical Education 67, no. 6 (2010): 406–411; Macgregor, J. M. and Sticca, R., “General Surgery Residents' Views on Work Hours Regulations,” Journal of Surgical Education 67, no. 6 (2010): 376–380; Carpenter, R. O. Spooner, J. Arbogast, P. G. Tarpley, J. L. Griffin, M. R. Lomis, K. D., “Work Hours Restrictions as an Ethical Dilemma for Residents: A Descriptive Survey of Violation Types and Frequency,” Current Surgery 63, no. 6 (2006): 448–455.Google Scholar
Nasca, T. J., “An Open Letter to the GME Community,” available at <http://www.acgme.org/acwebsite/home/nascaletter-community2_2009.pdf> (last visited February 26, 2013).+(last+visited+February+26,+2013).>Google Scholar
42 C.F.R. §§ 413.75-.83.Google Scholar
Id.; Madison, K., “The Residency Match: Competitive Restraints in an Imperfect World,” Houston Law Review 42, no. 3 (2005): 749–836.Google Scholar
42 U.S.C. 1395ww(h)(4)(E).Google Scholar
76 Federal Register 26490 (2011).Google Scholar
Lee, C. J., “Comment: Federal Regulation of Hospital Resident Work Hours: Enforcement with Real Teeth,” Journal of Health Care Law and Policy 9, no. 1 (2006): 162–215.Google Scholar
South Carolina v. Dole, 483 U.S. 203 (1987).Google Scholar
Id., at 206.Google Scholar
31 U.S.C. §§ 3729 – 3733; Elder, R. R., “Note: Expanded Hospital Liability Under the False Claims Act: An Unexpected Solution to the Resident Duty Hour Controversy,” Indiana Health Law Review 5, no. 1 (2008): 53–85.Google Scholar
Physician Payments Sunshine Act of 2009, S. 301, 111th Cong. (2009); Patient Protection and Affordable Care Act, Pub. L. No. 111-148, §6002, 124 Stat. 119, 689 (2010); Korn, D., “Financial Conflicts of Interest in Academic Medicine: Whence They Came, Where They Went,” Indiana Health Law Review 8, no. 1 (2010–2011): 1–42.Google Scholar
Restatement (Second) of Torts § 288(1) (1965).Google Scholar
210 ILCS 85 § 6. 14 (2006).Google Scholar
836 N.E.2d 635 (Ill. App. Ct. 2005).Google Scholar
Id.Google Scholar
Id., at 639–640.Google Scholar
Yowell, P., “Judicial Discretion in Adopting Legislative Standards: Texas's Solution to the Problem of Negligence Per Se?” Baylor Law Review 49, no. 1 (1997): 109–127; Scavuzzo, D. M., “Student Comment: The Resident Remedy: A Judicial Solution to the Problem of Sleep Deprivation,” UMKC Law Review 78 (2009): 263–290.Google Scholar
Madsen, T. A., “Whistleblower's Story,” The New Physician 53, no. 4 (2004): 8–10; CBS News, “New Docs Still Work Too Many Hours,” February 11, 2009, available at <http://www.cbsnews.com/stories/2004/01/13/health/main592994.shtml> (last visited February 27, 2013).Google Scholar
Institute of Medicine, supra note 2; Landrigan, C. P. Parry, G. Bones, C. B. Hackbarth, A. D. Goldmann, D. A., and Sharek, P. J., “Temporal Trends in Rates of Patient Harm Due to Medical Care,” New England Journal of Medicine 363, no. 26 (2010): 2124–2134.CrossRefGoogle Scholar
See Institute of Medicine, supra note 2.Google Scholar