Fatigue on the job can be hazardous to workers because it can increase their risk of injury. What about fatigue on the job for surgeons who are trying to heal injured workers? They work long and irregular hours as well, and it has been suggested that doctors who work longer hours may produce worse outcomes. One study that was just published in the New England Journal of Medicine shows that surgeons who work longer hours did not pose any more of a risk to their patients.

The study was led by Dr. Karl Bilimoria, the director of the Surgical Outcomes and Quality Improvement Center at Northwestern University’s Feinberg School of Medicine. The trial was named Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST). They allowed residents to work longer hours than was policy if they felt they should stay with the patient to either finish up a surgery or stabilize them if they were going through a health crisis. It is the first national trial to look at the duty hour limit policies of residents, which were enacted in 2003. Residents were limited to 80 hours a week, and could only work 28 consecutive hours with mandated time off between their shifts. First-year residents could only work 16 consecutive hours.

“When doctors have to hand off their patients to other doctors at dangerous, inopportune times, that creates vulnerability to the loss of critical information, a creak in the doctor-patient relationship and unsafe care,” said Dr. Bilimoria.

Two earlier studies looked at the correlation between hours worked and mistakes made by first-year residents (interns) only. Interns have different hour policies than residents. In those two earlier studies, when the 30 hour consecutive limit was reduced to 16 hours, the rate of serious medical errors fell significantly.

In the Northwestern trial they assigned residents to either of two groups. Both groups followed three parts of the hourly policies-

• They could not work more than 80 hours a week
• They had to take at least one day off in seven days
• They could not be on-call more than every third night

While all the trial participants followed these three rules, half were assigned to follow all the Accreditation Council for Graduate Medical Education (ACGME) rules. The other half were allowed to be more flexible with their hours. They could reorganize their hours in a way that would allow them, in their opinions, to care best for their patients and they could work more than the set 28 consecutive hours if they felt it was needed.

The researchers found that surgical outcomes were similar between the two groups, and the residents who were allowed flexible hours were less likely to miss an operation for one of their patients or leave early from such an operation. The flexible hours group was also much less likely to leave their patient in the middle of a crisis.

Dr. Bilimoria said he hopes the study will convince the ACGME to alter their hourly policies. He said patients want to know that they are being handed off safely, either once they are out of their operation or in stable condition. Those are more critical times when errors can be made if a new doctor comes in and they may not know all the subtleties of the case or the details of what has been going on.