Tuesday, September 21, 2010

Resident Work Hours- More Reform

OSHA (The Occupational Safety and Health Administration) has now entered the fray concerning physician resident work hours

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Public Citizen, AMSA, and the  committee of residents and interns have sent a petition to the Secretary of  OSHA. Who signed the petition?

According to Katherine Matos writing on the health care blog,

The petition requests that OSHA exercise the authority granted under §3(8) of the Occupational Safety and Health Act to implement the following federal work-hour standard:

Previous attempts to do this were via the regulatory powers of numerous graduate medical education programs and their ‘guidelines’ from the Accreditation Council of Graduate Medical Education Programs, whose threat was the de-certification of a specialty program or an overall withdrawal of the institutions graduate medical education credentials.

This new and innovative approach reveals the growing influence of student doctors and young doctors at a national level.

Arguments have gone on for decades regarding the near ‘servitude’ in post graduate medical education programs.

Program directors and trained doctors have often used the argument that shortening resident work hours would greatly impact on their ability to follow disease states, and impair patient care by frequent transfer of their care to other residents.

Residents have argued that the long work hours impact on the quality of care, and studies have shown the error rate increased substantially with long work hours and lack of adequate sleep periods.

There have been numerous studies demonstrating the adverse effects of sleep deprivation in resident physicians.

JAMA,   NEJM, A Study performed at the Johns Hopkins University,

Mental Health

  • One study described “house officer stress syndrome.” Caused in large part by sleep-deprivation and excessive work load, physicians-in-training may suffer from (1) episodic cognitive impairment, (2) chronic low-grade anger with outbursts, (3) pervasive cynicism, (4) family discord, (5) depression, (6) suicidal ideation and suicide, and (7) substance abuse.
  • Four studies demonstrated that residents are unhappy, face high levels of stress, and suffer “major problems” in their personal relationships with others.
  • Three studies demonstrated that on-call residents reported greater mood disturbance and increased negative mood than those who were rested.
  • One study found that as many as 30% of residents experience depression during their residencies.
  • A study published in the Archives of Internal Medicine found that 21% of residents reported depressed scores on the Center for Epidemiological Studies-Depression (CES-D) scale and that depressed responses increased with longer work weeks. Two other studies also found increased rates of depression among residents that correlated with high work hours.
  • Pregnancy
    • A NEJM study reported that premature labor and preeclampsia or eclampsia was twice as common among pregnant residents as the wives of male residents and that residents working more than 100 hours per week in the third trimester were twice as much at risk for preterm delivery than those that worked fewer than 100 hours.
    • The pre-term labor and preeclampsia risk was validated by a study published in Obstetrics and Gynecology.
    • One study found that infants born during residency significantly more likely to be born with intrauterine growth restriction.
  • Percutaneous Injuries (such as needlestick injuries)
    • A JAMA study of self-reported percutaneous injuries in residents found that substantially increased risk during day shifts after overnight call as compared with day shifts not preceded by overnight call.
    • “An Annals of Surgery study from 2005 found that 20 to 38% of all procedures in one urban academic teaching hospital involved exposure to HIV, HBV or HCV.”
    • A NEJM study found that 99% of all residents had suffered a needlestick injury by their final year of study. Fatigue was the second most common reason given for the injury.
  • The Response from OSHA thus far:

    ‘A clear shot over the bow of current resident work hours.

    A large part of this article is quoted from The Health Care Blog

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