Sleep Care

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Are Long Hospital Shifts Putting Patients at Risk?

The amount and quality of sleep a person gets each night can be directly related to the individual’s quality of work at their job. Sleepiness at work can affect a variety of different careers from truck drivers to accountants to heavy machine operators. But one of the professions currently and publicly dealing with the issue of adequate sleep and quality of work is medical residency.

It is very important for a medical student to learn each and every detail about their chosen profession in order to properly treat their patients. Medical students spend a minimum of three years in the residency program. A resident functions as a medical intern, assisting doctors as they treat patients in a variety of settings, many times in the emergency room. Residents are expected to work very long shifts while receiving very little break time. Previously the Accreditation Council for Graduate Medical Education (ACGME) established requirements that limited resident working hours to fewer than 80 hours per week, restricted extended shifts to 30 hours or less, limited average call frequency to no more than every third night, and mandated a 10-hour rest period between shifts. In 2003 the maximum work hours for residents were 24 hours straight. This presents an issue for many patients who are unaware that their doctor has been working for this length of time without sleep while diagnosing and treating them for illnesses. However, effective August 10, 2011 with recommendations from the Institute of Medicine, the ACGME has changed the maximum work hours for 1st year residents to 16 hours. However, the maximum 24 hours still remain in effect for 2nd and 3rd year residents.

 

With all of this debate about 24 versus 16 hours, length of rest periods, on-call regulations, etc., alertness is a very important factor to consider. The average adult needs 7-8 hours of sleep each night to effectively function. If interns are working 16 hours straight, that leaves only 8 hours left for sleep. It would seem impossible for the interns to achieve 8 hours of sleep when one takes into account drive time home, wind-down time, and other personal responsibilities. Alertness diminishes with every hour that passes without sleep. Laura Meinke M.D. at the University of Arizona Health Sciences Center, Tucson, AZstated that “Driving while sleep-deprived is equivalent to driving under the influence of alcohol. We would never allow our residents to practice medicine while under the influence, and it makes sense to examine the impact of sleep deprivation on our residents’ ability to learn and to practice medicine safely.”

 

However, hospital administration feels strongly against reducing resident and intern hours due to the financial and staffing issues it would cause. With interns working fewer hours, more interns would be needed which would increase salaries being paid. Also, some people believe that decreasing the hours worked would in turn decrease the endurance needed to work in the medical profession. It is not just the hospital administration that is against changing, some of the residents themselves feel the long hours are important to their training and do not want to give up their routine.

In addition to alertness, as hours pile up without sleep, residents are less able to retain the information they need to learn, and less able to make smart and safe choices for their patients. Sleep

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deprivation can cause the brain to shut down in certain regions. This causes sluggishness, slows reaction time and can cloud judgment. Residents deprived of sleep will be hampered in their ability to learn and convert new information into long-memories. All of these factors go hand in hand in decreasing alertness in medical residents.

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