Sleepless shifts of up to 26 hours that are routine for many of Canada’s 12,000 resident doctors are unacceptable, a panel of medical experts concludes in a report to be released Thursday.
The report, by the National Steering Committee on Resident Duty Hours, does not recommend limiting continuous shifts or the workweek to a specific number of hours – conditions that are in place in American and most European hospitals. Rather, the committee envisions implementing “fatigue risk-management” strategies in residency programs nationwide that would introduce measures, such as mandatory sleep breaks, to ensure residents are getting restorative shuteye.
“What we’re saying is that the status quo of residents working as much as 26 hours without sleep needs to change,” said Kevin Imrie, the physician-in-chief at Sunnybrook Health Sciences Centre in Toronto and a co-chair of the committee.
Dr. Imrie said he expects the report to have a near-immediate impact on the gruelling schedules of residents – recent medical school graduates who train under the supervision of licensed physicians – because its authors include representatives of the bodies that accredit residency programs, including the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada.
Resident work hours and the effect sleep deprivation has on patient care have been debated in the international medical community for years. The debate in Canada intensified in 2011 after a Quebec labour arbitrator ruled that the 24-hour shifts of a resident at a Montreal hospital endangered his health. Residents in Quebec now work up to 16 hours continuously.
That ruling followed proposals by the Institute of Medicine in the United States in 2008 to require naps and more structured shift changes to reduce the risk of fatigue-induced medical errors. Now, American residents are limited to 80-hour work weeks, and first-year residents cannot work more than 16 consecutive hours without sleep. Other residents may work 24 continuous hours. In the European Union, residents work an average of 48 hours a week.
Canada has no national standard for the hours residents put in. Hours are governed by contracts between hospitals or provincial governments and eight organizations representing residents.
The report says the conditions of those contracts vary significantly. For example, the maximum workweek ranges from 60 to 90 hours depending on the jurisdiction. Two contracts do not even specify a maximum.
Studies show that lack of sleep inhibits performance. But research is mixed on whether limiting duty hours results in fewer medical errors than those of residents in a sleep-deprived stupor. Shorter shifts means patients are more frequently handed from one resident to another, and it is during these transfers that crucial information can be lost.
“There is a consensus that a one-size-fits-all, hard number [on work hours] is not the solution,” Dr. Imrie said of the committee.