The New Yorker has an interesting article regarding medical residents, hours worked, and health outcomes. Residents used to work ridiculous hours. We’re talking 30 hour shifts. That is beyond ridiculous considering that even a little sleep deprivation has been shown to impair cognitive abilities as much as being drunk (which the author of the article both admits and seems to poo-poo as something non-doctors always say). The shift time was reduced in 2011 to “only” 16 hours. This resulted in an increase in the amount of handoffs which is what they call it when a doctor has to leave and hands off care to a new doctor. What they’ve seen is an increase of mistakes related to handoffs not being handled correctly.
To recap, 30 hour shifts lead to doctors making mistakes with their patients. 16 hour shifts lead to handoffs causing mistakes with their patients. Unless I missed something, the end result appears to be a wash. Just as many mistakes are being made either way. But then the author starts talking about how people feel and I just want to roll my eyes. Doctors feel like they’re not getting a complete education. Both doctors and nurses feel like the health outcomes are worse. Ugh.
From my point of view, the 16 hour shift is still infinitely superior to the 30 hour shift even though results so far appear to be the same. I would argue that part of the problem is that shifts should be even shorter. 16 hours is still an incredibly long time and doctors are expected to create handoff notes before they leave which is the time when they are most likely to cause mistakes due to sleep deprivation. The only difference is it’s a fresh doctor that’s making mistakes because of the sleep deprived notes of the previous doctor.
The funny thing about the article is there’s no mention of doing something simple like changing the handoff procedures. To me it’s obvious that’s what needs to be analyzed and changed. I can’t find a link to it now, but there was a study done about ER patients with heart problems and they studied various hospitals, some of which used a physical checklist of things for the doctor to do and some which just had the doctors just perform like they normally do. The hospitals with the checklists had a ridiculously higher quality of outcomes than the non-checklist hospitals. The handoff procedure just screams for something similar to a checklist to be created and used religiously. To me, the obvious addition is a simple question. Why? If the doctor wants to stop a medicine they must both write that they are doing so and the reason why they are doing so with pointers to the tests/observations that made them do so. They should do this at the time they are performing the action and not wait until the handoff.
The end result should be that no handoff is necessary. Yes, it’s still good and important for doctors to talk to each other, but relying on it is a recipe for disaster as much as working 30 hours is.