Well, brought on by this, that’s my inferred conclusion from this:
Conclusions: Interns made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts. Eliminating extended work shifts and reducing the number of hours interns work per week can reduce serious medical errors in the intensive care unit.
and backed up by this:
Conclusions: Eliminating interns’ extended work shifts in an intensive care unit significantly increased sleep and decreased attentional failures during night work hours.
OK, so maybe it doesn’t say they should emulate ED docs, exactly, but it makes sense to me. I wouldn’t want an ED doc who’s been up for 36 hours making my TPA decisions, and ED docs, though thought to be not too bright by the rest of the medical staff, are smart enough not to work themselves to death and to avoid the hospital whenever posiible (this excludes the sub-genus meetinglover, who lives at the hospital anyway).
Funny, I watched my dad work shifts throughout my adolesence, and said to myself “I’m going to be a professional, so I don’t have to work shifts”. And then I went into Emergency Medicine. Shifts Until Retirement.
via Kevin, MD
How about if we all behaved like ED docs: Admit anyone with chest pain even if clearly not indicated, start antibiotics on everyone without any cultures, give fluids to everyone regardless of cardiac status, dump everything into medicine just to cover our asses, misinterpret EKG’s on a regular basis.
On the other side, at least we’de be better rested!
Wow… That last comment was spoken (er, written) by someone who either has the misfortune of working somewhere with a very poor ED staff, or who has no knowledge of how Emergency Medicine works…. Either way, that’s unfortunate.
(Posted by someone who used to be in emergency medicine, and still has great respect for good ED docs, despite the personal decision to transfer to Internal medicine. ;)
There’s so much wrong in there, I don’t even want to open the topics. Maybe someone on the next shift can do it.
Working 36 consecutive hours is madness. In the large mainframe computer business in the 1960’s a hardware tech support engineer flew in and worked on a problem for 36 hours straight. In an attempt to isolate the problem by “building a logic trap” he accidently injected 48 volts AC into a 5 volt DC logic circuit by neglecting to kill the power before altering the wiring. The results were catastrophic!
It turned a ‘five minute problem, once every two days’ into a total shutdown of a major industrial plant the size of Central Park, for four days. We took him to the motel and put him on a plane back to HQ the next day, before the customer could kill him. It took hundreds of manhours and $30K in parts to get back to the original ‘five minute problem, once every two days’ starting point.
No one should work more that 18 hours in 24. Judgement goes to hell and it often has dire consquences.
I think I’ll be ‘unwise’ enough to tackle one of those topics: “Admit anyone with chest pain even if clearly not indicated”.
The writer has clearly not been around the ER on a Friday or Saturday night when every Public Intoxication arrestee in the city jail develops chest pain. They all seem to know that it’s more comfy to sleep it off in an ER bed than in the jail cell. They get the standard EKG and cardiac blood profiles, along with Blood Alcohol test. When the BA is down to some protocol value, they are released back to jail and not admitted.
You’d think the jailers would know the ‘game’ and stop calling the paramedics every half hour. But they can’t. Some municipal Risk Management Analyst has calculated the liability cost of just one prisoner actually having a heart attack and has instituted the policy that all chest pains go to the ER, no exceptions!
They do go the to ER, yes; but they don’t get admitted, no.
Erv,
Clean-up in aisle four.
Nothing to add.
Azygos
I thought several studies were done a few years ago pointing out that overworked and overtired interns/residents were more likely to make mistakes and that the teaching hospitals were to take steps to ensure not only the safety of patients but the well-being of the med students/interns/residents. So is this study really new or simply another “warning light” blinking on and off in the void of the medical teaching facilities? While I am not a doctor, nor do I play one on television, even I, in my miniscule world of non-medical alignment, can see that working non-stop for 36+ hours is not only detrimental to the decisionmaking process, but also to health and wellbeing of the medical staff. Physicians, heal thyselves – then come and heal us when you’re awake! Good luck everyone – and thank god for Starbucks.
No question that working less consecutive hours helps everyone. There are so many problems to adopt that that most residencies just stick to what’s in place…. hopefully this evidence can help change that.
Leo
I actually took part in this study. What makes it new and unique is it’s throughness and methodology. It was so thorough that I politely removed myself from the study after 3 months of internship…I was so overworked, I didn’t have time to think about what I was entering into their database!