A Scheduling Toolkit for Medical Professionals
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| Cost |
| Widespread reduction of house staff work hours would require redistribution of responsibilities and hiring of additional physicians and physician extenders. The numbers and types of providers that would be needed have not been adequately quantified, nor have the costs of hiring such providers. Potential downstream savings if these providers reduce errors and inefficiencies also need to be considered. Nuckols and Escarce modeled the cost effectiveness of reducing work hours to 80 per week (2005) . Their research suggests that a decrease in adverse events of 18.5% to 30.9% would be necessary in order for the reform to be cost-neutral for teaching hospitals. The HWHHS group intervention schedule found that a reducing intern work hours to <65 per week resulted in reductions in serious medical errors to a degree that might achieve cost neutrality for hospitals, but further research in this area is needed. |
Safety Considerations for House Staff on ANY Schedule |
| Safe Commuting |
| The HWHHS group conducted a prospective, nationwide, survey of 2,737 medical residents in their first postgraduate (intern) year after medical school. The survey collected detailed information on work hours, extended duration work shifts, motor vehicle crashes, near miss accidents, medical errors, percutaneous injuries (i.e., injuries from needle sticks and scalpel laceration) and ‘fall asleep’ incidents. Motor vehicle crash risk during the commute from work was more than doubled, and near-miss motor vehicle accident risk increased nearly six-fold after extended duration shifts compared to non-extended duration shifts (Barger 2004). In situations where doctors work multiple nights in a row, or feel too tired to safely drive home, accommodations should be made for them to get home safely. While a well designed scheduling system in concert with an active fatigue management program can eliminate much of the risk of sleep-deprivation related motor vehicle crashes, a taxi cab voucher program (to get home from work and back again for the next shift) should be considered. Such a program should be used infrequently in an ideal system, but may be an important safety mechanism to be used in the occasional situation where housestaff are extremely tired despite a well-designed schedule and a robust comprehensive fatigue management program. |
| Napping |
| Space for naps should ideally be provided so that housestaff working at night can rest when it is possible and safe for them to do so. Keeping naps very brief (i.e., less than 20 minutes) will minimize the risk of sleep inertia, which can be more potent in the first few minutes of awakening than the effects of even extreme sleep deprivation. Ideally, even a brief nap should be followed by a protected time period of another 20 minutes, so that housestaff have a chance to recover from any sleep inertia. In many emergent situations, such protection by another covering house officer may not be feasible, but should be encouraged where it can be accomplished. |