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Residents need more sleep?Dec 3, 2008 06:46 EST
The Institute of Medicine released a report yesterday recommending that, in addition to capping overall hours at the current 80/week, shifts should be no longer than 16 hours followed by a mandatory 5-hour nap and implement a ban on moonlighting. See http://www.nytimes.com/2008/12/03/health/03doctors.html?_r=1
This article cites that errors go down when housestaff sleep more, and work-hours rules have led to more inadequate signouts. True, but...what's more dangerous, a resident who hasn't slept or one that doesn't know how to recognize and manage disease? Won't shortening shifts lead to more signouts? And would housestaff, when forced to, actually sleep if they had to stay in a hospital call room for 5 hours? Also, the error rate, according to their own statistics, is 35% with 5 hours of sleep, but <27% if they sleep more. Is that a clinically (or statistically) meaningful difference?
These recommendations will cost an additional $1.7 billion in their own estimates to cover nap time. Doesn't mention whether this figure includes the effect of banning moonlighting. Medical education ain't getting any cheaper, and a moonlighting ban will only add to housestaff debt burden.
The only feasible way to go along with the IOM's recommendations, IMHO, is that residency will need to be lengthened so housestaff get the adequate clinical experience to become independent operators. No resident would support that and would gladly give up nap time to shorten training.
The added irony is that attendings have no "mandatory nap time". The concept itself seems ridiculous. Should attendings be forced to take naps, too?
Brian Choi, Asst Moderator