The major argument made in favor of shorter physician shifts is fatigue. Proponents of short shifts claim that, the longer the shift, the likelier medical staff is to make errors in patient care. But what if that line of thought overlooks a key factor that influences patient outcomes?
Handoffs are risky, Calvin Kagan, MD, a resident at The Johns Hopkins Hospital in Baltimore, wrote in a column for The Baltimore Sun. While they are inevitable because physicians can't work without breaks, rest and shifts ending, minimizing handoffs minimizes errors in handling patients.
"I work 26- to 30-hour shifts every four to five days," Dr. Kagan wrote. "During the 30-hour shifts, known as the 'on call' day, I admit new patients. When I bring someone into the hospital on my call shift, I become an expert on the patient's medical history and current illness. I then serve as the patient's primary doctor throughout his or her hospital stay. Mistakes are avoided and the quality and the safety of care are improved."
The consequence of shorter shifts is a heavier reliance on a day and night team of physicians, with more shift changes, more hand offs and, inevitably, more important details about patients being left out. Long shifts also give physicians more uninterrupted time to diagnose, test and become acquainted with a patient's condition, Dr. Kagan wrote.
He works in one of 63 hospitals taking part in a study that will examine the impact of work hour restrictions on safety, among other things. Hospitals in the study have been randomized in two categories, one limiting first-year physicians to 16-hour shifts and another placing no limitations on shift length with the caveat of no one being scheduled more than 80 hours per week. Dr. Kagan wrote that while the study has not yet concluded, he is confident based on his experience that the results will support his perspective on long hours.
"At the start of my first year as a physician, I was a supporter of the 16-hour schedule but have since evolved," he wrote. "Now, I tell folks that I would prefer my loved ones be seen at a hospital with 30-hour call. Through my experience with both schedules, I simply believe that this schedule is safer."