Wednesday, October 13, 2010

Resident Work Hours: The Solution

I don’t know why I didn’t think of it sooner. Or like many great ideas, why didn’t someone else come up with it? This morning at 4:30 as I lay awake having just received a consult from infernal medicine for an elderly lady being admitted with gallstones, atrial fibrillation and acute dehydration which could have waited until 7:00 a.m. today or even tomorrow, it hit me. I have the solution to the resident work hours controversy.

A few years ago, I was in the Navy and served on a ship. Crew members “stood watch” which consisted of a rotations of four hours on duty and eight hours off duty. Thus, each crew member worked eight hours per day but the work time was divided into two four hour shifts. To me this would be the perfect solution to the resident work hours dilemma.

I know, you are saying, “But Skeptical Scalpel, wouldn’t that mean six patient hand-offs per day?” Yes, of course it would. But according to the proponents of reduced work hours for residents, hand-offs are not a problem for continuity of care or patient safety. So if two or three hand-offs per day are OK, why not six?

There are a few issues that need to be worked out. For example, surgical residency training would have to be increased to 8 or 9 years duration. Operations would have to be scheduled carefully to enable a resident to participate from start to finish. All operations would have to last fewer than four hours. Each residency position currently filled by a single individual would require three people. Who is going to pay for that? Well, no one is concerned about who is going to pay for the newly adopted regulations limiting first-year trainees to 16 hour days. Then there are weekends, vacations and holidays which would mean that extra residents would be needed to cover.

Since I wrote this rather hurriedly, I may have overlooked something. I will give you 45 days to comment and then I will implement these new and improved work hours as stated.

6 comments:

Junior said...

you spelled internal wrong.

Skeptical Scalpel said...

No, I meant "infernal."

Gray said...

You don't have the comment period thing down correctly. It's 48 hours, but without spelling out any specifics. Better yet appoint a czar to implement the rules as he sees fit. If the czar has a Harvard or Princeton background, he will obviously be working in our best interest.
Hey, I know a guy with a Princeton background who might be interested in a phony-baloney government job..

Skeptical Scalpel said...

The time period of 45 days was selected because that's what the ACGME did. They posted the proposed new rules, asked for comments and then implemented the rules as posted. The comments were ignored. Sorry, if there is a czar, it will be me.

Tx Doc said...

I did a tour in the USN - HM#, USS Saratoga, CV-60 in the 70's - Hospital department did day shift, had two full time night staff, and 4 section call for the rest. We did okay - but the cumulative effect on ship departments - particularly Engineering and Deck - of 4 on, 4 off or 4 on 8 off was significant - huge issues with fatigue, etc. Not so simple.
Add in the commute issue - need a bunkhouse at the hospital?

Skeptical Scalpel said...

Tx Doc, you of course are correct. It would be back to the days when residents lived at the hospital.

I have a confession to make. I wasn't serious. It would be a little impractical.

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