Institute of Medicine recommends stricter resident duty hour regulations to prevent medical errors

Jan 04, 2010

At the request of the House Committee on Energy and Commerce as part of an investigation into preventable medical errors, the Institute of Medicine (IOM) has issued a report recommending further restrictions regarding duty hours for resident physicians and other actions to reduce resident fatigue and ensure patient safety, according to an article published in the January issue of the Journal of the American College of Radiology (JACR).

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) set duty hour limits across all medical specialties nationally in order to promote safe patient care and resident well-being. The increasing acuity and intensity of in teaching institutions and the scientific evidence of the negative effect of on performance were cited as reasons for the new duty hour requirements.

"Compliance with the current Accreditation Council for Graduate Medical Education duty hour requirements is assessed by an anonymous annual resident survey in addition to periodic site visits," said Martha B. Mainiero, MD, lead author of the article. "When a survey indicates that a significant number of residents work beyond duty hour limits, the ACGME will perform an immediate site visit of the program as well as a focused review of the institution," said Mainiero. Data from resident surveys since the institution of the common duty hour requirements show that each year there are fewer residents who report working beyond duty hour limits.

The new IOM recommendations focus more on reducing fatigue related errors by assuring that residents get regular opportunities for sleep each day than by reducing the maximum weekly work hours. The current ACGME duty hour requirements state that residents must not work more than 80 hours per week averaged over 4 weeks, and must be provided 1 day in 7 free from all educational and clinical responsibilities, averaged over 4 weeks.

"The radiology community supports the current ACGME requirements but recognizes that there has been inadequate study of the outcomes of the current duty hour regulations and that there continues to be issues with compliance with those regulations. Therefore, we feel these issues should be addressed with more rigorous monitoring of duty hours before implementing new duty hour requirements," said Mainiero.

"The ACGME is currently reviewing the IOM's recommendations but will have little choice but to take further action in this area," said Mainiero.

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