Most hospitals insist on surgical checklists, falls prevention measures and frequent handwashing by staff, all in the name of patient safety. It's puzzling, then, that an almost universal practice that puts people at risk persists: making medical residents work 24-hour shifts.
That is about to change in Quebec; an arbitration ruling in June found these shifts posed a danger to the health of residents and contravened the Canadian Charter of Rights and Freedoms. It gave that province's hospitals six months to change schedules to 16-hour shifts.
Other countries are far ahead of Canada in this respect. The Accreditation Council for Graduate Medical Education in the United States last year reduced shifts for its first-year medical residents (who are most vulnerable to fatigue) to 16-hour days. In Europe, the working time directive limits junior physicians to working no more than 48 hours a week.
Kevin Imrie, vice-president of education for the Royal College of Physicians and Surgeons of Canada, said many provinces are considering reduced hours.
Studies have found residents who work around the clock make more serious, life-threatening mistakes and more diagnostic errors than those on shorter shifts. The Quebec labour arbitrator expressed a concern of many when he wrote patients “may become victims of medical errors.”
Virtually every doctor trained in Canada has endured 24-hour shifts. Adam Kaufman, president of the Canadian Association of Interns and Residents, a group that represents more than 8,000 doctors, said “our big concern is making sure patient safety remains number one and resident safety is addressed.”
One additional best practice should accompany reduced hours. During handovers, the potential for mistakes exists, which is why the United States has special “handover” rooms to ensure a more formalized process during shift change.
To make patient care safer and working conditions more humane, hospitals and educators should start at the bedside, and get a few doctors a little extra sleep.
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