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Resident Doctors' Long Work Shifts Could Bring Peril to Patients

FRIDAY, April 14, 2023 -- Early-career doctors were more likely to make mistakes when they had long work weeks or extended shifts, new research reveals.

Their patients were also more likely to experience adverse events as a result, according to the study. Moreover, doctors in their second year of training or above were more likely to experience safety events themselves, such as near-miss vehicle crashes and on-the-job exposures.

Nationwide work guidelines bar extended shifts for first-year resident physicians, but even second- and third-year physicians make these errors, researchers from Brigham and Women’s Hospital in Boston learned.

“More experienced residents need sleep, just like anyone else, and when they work extended shifts or put in long weekly hours, they often do not have the opportunity to get the sleep that they need and are just as susceptible to these risks as first-year resident physicians,” said corresponding author Laura Barger, an associate physiologist in the Division of Sleep and Circadian Disorders.

“Our research shines a light on an issue that affects both resident physicians and their patients and should prompt a reexamination of national guidelines," Barger said in a hospital news release.

In 2011, guidelines set by the Accreditation Council for Graduate Medical Education (ACGME) limited first-year residents to work shifts of 16 hours or less. This was based on recommendations from the National Academy of Medicine and informed by studies conducted by Brigham investigators over the last four decades, researchers noted.

However, the council endorsed extended-duration work shifts of up to 28 consecutive hours for more experienced resident physicians. All residents were allowed to work as much as 80 hours a week.

In the European Union, meanwhile, resident physicians are allowed to work no more than 48 hours per week.

To study the effects of longer shifts and work weeks on second-year and more experienced residents, researchers surveyed more than 4,800 U.S. resident physicians over eight academic years -- from 2002 to 2007 and 2014 to 2017. Respondents answered questions about patient safety outcomes as well as their own health and safety.

Working more than 48 hours in a week was associated with more medical errors, preventable adverse events, as well as near-crashes, occupational exposures, injuries through the skin and inattention.

Risks rose for residents who worked even longer work weeks, logging 60, 70 and up to 80 hours.

Those whose work weeks exceeded 60 hours were more likely to report errors resulting in a patient's death.

Those who worked at currently permitted limits had roughly three times the risk for a medical error or preventable adverse event, compared to residents whose hours were similar to those in Europe.

“Working just one extended-duration shift in a month was associated with increased risk of medical errors as well as having a near-collision on the way home from work,” co-author Matthew Weaver, of the Division of Sleep and Circadian Disorders, said in the release. The council endorses extended-duration shifts of up to 28 straight hours for all residents, meaning they are often working without adequate sleep, he added.

While the study is based on self-reported data, safety questions were mixed in with other health questions, including caffeine use and exercise. Participants did not know the study's aim.

The findings were published online April 12 in BMJ Medicine.

In an accompanying editorial, the authors called for nationwide limits on work hours and extended shifts. They also recommended screening for sleep disorders and providing sleep health education resources for resident physicians.

“The harm of long work weeks and extended shifts affects experienced senior resident physicians in the same way as it does first-year resident physicians and that harm is reaching patients,” said senior author Dr. Charles Czeisler, chief of sleep and circadian disorders at Brigham and Women's. “In other parts of the world, physicians are effectively trained while working safer hours. Our findings provide further evidence that it is time for guidelines in the U.S. to change to ensure that all resident physicians, regardless of their experience, have safer work-hour limits.”

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