WIHI: Alert to Change: New Models for Residency Work Hours

Date: January 27, 2011
 
Featuring:

• Christopher P. Landrigan, MD, MPH, Director, Sleep and Patient Safety Program, Brigham and Women’s Hospital
• David B. Sweet, MD, FACP, Program Director, Internal Medicine Residency, Summa Health System
• James F. Whiting, MD, Surgical Director, Maine Transplant Program and Surgical Residency Program Director, Maine Medical Center
• Don Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement  

 

Rules are rules, but efforts to limit the number of hours medical residents can work before getting rest and sleep have not gone down easily in the US. The latest set of regulations from the Accreditation Council for Graduate Medical Education (ACGME), focused especially on first-year residents, is scheduled to go into effect in July 2011.

 

Amid ongoing debate about research tying long hours spent taking care of hospital patients to impaired judgment and an increased likelihood of making errors (or harming oneself), and what are fair and appropriate remedies, a growing number of residency programs are forging ahead. They’re redesigning schedules and handoff processes not only to comply with ACGME rules, but to adopt systems that are more team-based and that promise to better protect the health and safety of patients and providers alike.
 
There’s no magic, one-size-fits-all solution, but WIHI host Madge Kaplan welcomes a group of experts to shed light on trailblazing ideas and system redesigns that everyone engaged in training health professionals can learn from. At Summa Health System, for example, where Dr. David Sweet heads up the residency program, 16-hour limits are the organizing principle for all trainees. And that’s led to innovations that are gradually achieving greater buy-in and improved care. Dr. James Whiting is working hard to get ahead of the curve in Maine, and other residency programs that are actively linking training to patient safety are also highlighted.
 
Dr. Chris Landrigan has made a major contribution to the research concerning sleep and safety, and both he and Dr. Don Goldmann are keenly aware of the ways in which educational programs for residents, including access to faculty, have historically evolved around open-ended work schedules. There are big challenges ahead. But now, there are also models that can be studied and innovations that can be introduced.