Same workload with fewer hours increases number of medical errors

April 26, 2013

What causes medical mistakes and diagnostic errors? Studies indicated that excessively long shifts worked by medical residents could be to blame. In 2011, regulations went into place to restrict the number of continuous hours that first-year residents spent on call from 24 hours to 16 hours.

The latest research published in JAMA Internal Medicine was surprising. It found that interns working under the new regulations were actually making more errors and still reported suffering from fatigue and depression.

Before the new rules took effect, 19.9 percent of interns reported making a mistake that harmed a patient. That number increased to 23.3 percent after the shift-limiting rules went into effect. Study author, Dr. Srijan Sen at the University of Michigan, said in a statement. "That's a 15 percent to 20 percent increase in errors - a pretty dramatic uptick, especially when you consider that part of the reason these work-hour rules were put into place was to reduce errors."

This prompted the researchers to look at why the reduction in hours failed to reduce the overall error rates.

Fewer hours, same expectations

The study authors point to one of the possible reasons as work compression. Hospitals did not increase funding to hire new staff following the rule change. Residents worked fewer hours at the hospital, but reported that they still needed to accomplish the same amount as residents who had worked longer shifts. There was less time to think about or revisit patient-care decisions.

Since individuals generally make more mistakes in timed test results, it was thus not surprising that interns who had less time to do the same work would make more errors.

Patient handoffs increased

Another potential cause was the number of patient handoffs increased. Miscommunication could mean that the next doctor or nurse assigned to care for the patient missed an important piece of information regarding patient allergies, which could lead to an anesthesia error. With the reduction in shifts, handoffs more than doubled.

The authors of the study admit their findings are preliminary and based on self-reports of the residents themselves.

Disclosure of errors may not always be forthcoming

Another area of concern highlighted by researchers at the University of Washington is the prevalence of medical error disclosure by residents and students. A study found that trainees were much more likely to report obvious errors rather than ones the patient might not recognize. One conclusion was that medical educators needed to improve training on the open disclosure of harmful medical errors.

If you or a loved one suffers a serious complication or injury during time spent in the hospital, it could be that a mistake or the negligence of a nurse or doctor was to blame. An experienced medical malpractice attorney can review your individual circumstances, explain your rights and discuss whether remedies might be available.

Article provided by Hal Waldman & Associates
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