Fatal errors more likely on 24-hour call

Harvard sleep scientists say residents' hours still put patients at risk.

By Myrle Croasdale, AMNews staff. Jan. 22, 2007.

Patients are dying at the hands of tired medical residents, according to Harvard sleep scientists, because the work-hour limits imposed in 2003 are not preventing sleep deprivation.

Their research reveals that first-year medical school graduates who worked five shifts of 24 hours or more during a month were three times more likely to make an error that contributed to a patient's death.

"Academic medicine is failing these doctors and their patients by requiring exhausted doctors to work 30-hour marathon shifts," said Charles Czeisler, MD, PhD, co-author of the study and director of sleep medicine at Harvard Medical School and Brigham and Women's Hospital in Boston. "The human brain doesn't function correctly when working 30 hours straight."

David C. Leach, MD, executive director of the Accreditation Council for Graduate Medical Education, the organization that regulates resident hours, said trimming call hours further would not necessarily improve patient safety.

"[Dr.] Czeisler's study has given us a little truth," Dr. Leach said. "Residents who work 24 hours self-report they are prone to more errors. He has not given us a deeper truth. The problem is more complex than 16- vs. 24-hour shifts."

The study builds on previous research from Harvard that compared interns who worked an average of 80 hours a week with call periods of 24 hours and longer, to interns working 63 hours a week, with call limited to 16 hours. The interns working the longer schedule made 36% more serious medical errors.