Study links errors by US doctors to long hours

WASHINGTON, Dec 13 (Reuters) The marathon hours worked by doctors-in-training in US hospitals are leading to an alarming number of fatigue-related medical errors that often kill patients, researchers said.

When medical interns work shifts lasting from 24 to 30 hours, the risk of them committing serious medical mistakes that harm patients skyrockets, researchers at Brigham and Women's Hospital in Boston found.

The interns were 4.1 times more likely to have made fatigue-related medical errors that resulted in a patient's death after working five or more of these shifts per month than in a comparable month when they did not work such long hours, the researchers found.

The study cast a new spotlight on a practice dating back to the 1890s in US hospitals of compelling young doctors-in-training to work extremely long shifts.

Supporters of the practice say it is vital for a new doctor to follow individual patients for the entire course of a hospital stay, in part to learn about the courses of various illnesses.

The findings were based on a survey of 2,737 interns of various medical specialties in US hospitals.

''We found that for every 100 interns working for a year, they on average made 200 significant medical errors, 20 significant medical errors that caused a preventable injury to their patients and 5 serious medical errors that caused the preventable deaths of their patients,'' Dr. Charles Czeisler, who led the study, said in a telephone interview.

If these findings are applied to all 100,000 young doctors working such schedules at US hospitals, he said, that means there are nearly 100,000 significant medical mistakes, tens of thousands of preventable injuries to patients and thousands of preventable deaths that are fatigue-related every year.

Czeisler is chief of the Division of Sleep Medicine at Brigham and Women's Hospital and a professor at Harvard Medical School. The study appears in the Public Library of Science journal PloS Medicine.

The mistakes do not reflect an intern's medical knowledge, but rather are mental slips and lapses typical of exhaustion, Czeisler said.

The study examined the issue of these doctors-in-training working within work-hour limits established by the Accreditation Council for Graduate Medical Education.

The organization has put in place work-hour guidelines for US interns, limiting them to a maximum of 30 straight hours and a maximum of 80 hours per week averaged over four weeks.

''Considered as a whole, the evidence demonstrates that academic medicine, by clinging to this 19th century tradition, is failing both doctors and their patients by routinely requiring exhausted doctors to work these marathon 30-hour shifts,'' Czeisler said.

''The human brain simply does not perform reliably for 30 consecutive hours without sleep.'' The Service Employees International Union, the largest union for medical interns and residents at US hospitals, said the findings are even more frightening because hospitals are permitted to schedule interns to work a shift lasting 24-30 hours as frequently as two to three times per week.

The union repeated its call for legislation from the US Congress to impose limits on resident work hours.

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