Long Hospital Shifts, Lack of Sleep Can Kill, Study Says

By Kathleen Fackelmann

Medical residents are routinely scheduled to work shifts that last 24 hours or more, yet a study out today suggests that these sleep-deprived doctors are at high risk of making medical mistakes that can harm or even kill patients.

“Working for more than 24 hours is hazardous,” says sleep researcher Charles Czeisler at the Harvard Medical School. Scores of studies show that people who stay awake for 18 hours straight can have trouble thinking clearly and can zone out or nod off suddenly.

In July 2003, the Accreditation Council for Graduate Medical Education, a Chicago group that accredits medical residency programs, limited work schedules to no more than 80 hours in a week. But the rules still allow marathon shifts that last up to 30 hours.

Many medical residents must pull these extra-long shifts twice a week — a schedule that leads to extreme fatigue, says Simon Ahtaridis, president of the Committee of Interns and Residents, a 12,000-member union calling for more reform of work hours.

Czeisler and his colleagues had 2,737 first-year medical residents complete a monthly survey that asked detailed questions about their work schedule, sleep and days off. During the year-long study, the residents also were asked to report any medical errors they’d made while on duty.

The researchers found that when residents reported working five marathon shifts in a single month, their risk of making a fatigue-related mistake that harmed a patient increased by 700%. And the risk of making an error that resulted in a patient’s death shot up by 300%. The report appears in the journal Public Library of Science (PloS) Medicine.

The residents in this study reported making 156 fatigue-related errors that injured a patient and 31 mistakes that led to a death, Czeisler says. About 100,000 medical residents in the USA routinely work these extended shifts, Czeisler says. “These data suggest there are tens of thousands of preventable injuries to patients annually.”

Richard H. Bell Jr., assistant executive director of the American Board of Surgery, contends that 24-hour shifts are sometimes necessary to provide patients with crucial continuity of care. For example, residents might need 24 hours to get a patient through surgery and then to pass on the details of the case to the next resident, he says. (c) Copyright 2005 USA TODAY, a division of Gannett Co. Inc.