The study found that limiting the number of hours worked continuously by medical trainees failed to increase the amount of sleep each intern got per week but dramatically increased the number of potentially dangerous handoffs of patients from one trainee to another.
Handoff is a medical term which refers to practice of doctors and nurses of passing patients to others once their shifts are over. The reductions in work hours also decreased training time. Prof Norman Williams, president of the Royal College of Surgeons, said doctors will lose their professionalism if they develop a 'clock on and clock off attitude'.
In 2011, stricter national regulations reducing the continuous-duty hours of first-year resident physicians from 30 to 16 were put in place on the belief that limiting trainees' work hours would lead to more sleep and that less fatigue translating into fewer serious medical errors.
But Sanjay Desai, leader of the new research says data does not support this. "The consequences of these regulations are potentially serious," says Desai, an assistant professor at the Johns Hopkins. "Despite the best of intentions, the reduced hours are handcuffing training programs and benefits to patient safety while trainee well-being has not been systematically demonstrated."
According to Desai, the 16-hour limit was put in place without any evidence that it would improve patient safety and outcomes.
Desai compared three different work schedules in the months leading up to the 2011 change. For three months, groups of medical interns were assigned randomly to either a 2003-compliant model of being on call every fourth night, with a 30-hour duty limit, or to one of two 2011-compliant models.
Interns on the 16-hour limit schedule did sleep an average of three hours longer during the 48 hours in their on-call period than those working 30-hour shifts but there was no difference in the amount of sleep they got across a week.
"During each call period the interns had 14 extra hours out of the hospital, but they only used three of those hours for sleeping," Desai says. "We don't know if that's enough of a physiologically meaningful increase in sleep to improve patient safety."
The researchers found that the minimal number of patient handoffs between interns increased from three for those working 30 hours to as high as nine for those working 16-hour shifts.
More handoffs led to less continuity of care and more room for errors. The minimum number of interns caring for a patient during a three-day stay increased from three to five.
Desai says their study showed that educational opportunities suffer greatly from the 16-hour restrictions.
Before the limits, interns did all patient admissions and spent the next 24 hours following them. Now there are times when interns cannot admit patients and those who do cannot see them through initial assessment.
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