Since then, officials with the Chicago-based ACGME said only a tiny
percentage of residents have violated the controversial guidelines,
which they believe have led to safer conditions and improved training
for future physicians.
But that optimistic assessment is being sharply questioned in a new national study which found that 84% of first-year residents violated at least one of the new work-hour rules in the first year after the guidelines were established in July 2003. The study, which appeared in the Sept. 6 issue of the Journal of the American Medical Association, included monthly reports from some 4,000 residents that highlighted routine violations of nearly every aspect of the work-hour rules.
Christopher Landrigan, a physician at Brigham and Women's Hospital in Boston who is the lead author of the study, said that even the tougher ACGME guidelines are unsafe for residents -- and patients. He said he hopes the stark results of his study "stimulate the ACGME to rethink its work-hour limits."
"We need to find a way to redesign the existing work-hour limits into something that is safer," he said.
Residents self-reported violations in 604 of the 707 residency programs they represented, the study found. In all, there were violations reported in 314 of 346 hospitals. (All 20 hospitals in Pennsylvania with residents participating in the Web-based survey violated the work hours, the authors learned.)
Researchers who conducted the JAMA study said several factors contributed to the high rates of noncompliance, including the absence of "financial and technical support."
"Programs may not have the resources or expertise to redesign their schedules to the extent required," the researchers wrote. "In addition, house officers are typically unwilling to depart precipitously at the scheduled change of shift when an emergent patient-care situation demands their continued presence."
Officials with the ACGME questioned the wide-ranging pattern of violations in the survey, pointing out that it included only a small percentage of the 100,000-plus future physicians now working as residents. Coinciding with the release of the JAMA study last week, the ACGME sent out its own news release indicating only about 3% of residents surveyed in 2004-05 reported working more than 80 hours per week during the previous four weeks. The ACGME said it has received an estimated 90% response rate from the approximately 100,000 residents it has surveyed over the past three years on the issue. Also, more than 30,000 residents have been interviewed about work hours during on-site visits, officials said.
"I'm very confident that at least 95% of all residents are not working more than 80 hours a week," said David Leach, a physician who is executive director of the ACGME.
In the meantime, the authors of the JAMA study questioned the credibility of the accrediting council's methodology pointing out that residency programs do not have a standard method of collecting information about work hours. The researchers also said most programs -- and residents -- are likely to be reluctant to self-report violations because the ACGME has the authority to yank accreditation.
For his part, Leach said the ACGME is focusing its efforts on programs that have failed to comply with the standards. "A small but definite number haven't come into compliance yet," he said. "And we're squeezing them."
The survey is paired with a second JAMA study indicating that long shifts for residents lead to increased risk of medical errors, injuries and exposure to contaminated fluids.
To some, the studies were a wake-up call to the industry and its young doctors. "These studies raise troubling questions about compliance with standards that were developed to reduce medical errors due to work-hour related fatigue," Carolyn Clancy, a physician who is director of the federal Agency for Healthcare Research and Quality, said in a statement.
Written by Michael Romano
Source: ModernHealthcare.com
Studies' findings show polar-opposite conclusions