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Can you share your sources for that? I've heard from medical residents that longer shifts do not result in better patient outcomes. The first paper I Googled ag

Can you share your sources for that? I've heard from medical residents that longer shifts do not result in better patient outcomes. The first paper I Googled agrees - it shows longer shifts for surgeons are not safer (longer shifts had 9.1% rate of complications/death and shorter shifts had 9.0% rate): http://www.nejm.org/doi/full/10.1056/NEJMoa1515724 http://www.nejm.org/doi/full/10.1056/NEJMoa1515724

arkades 9y ago
What the literature consensus largely shows is that there's a roughly equal swap between more sleep/shorter hours resulting in more mistakes due to hand-offs, and longer shifts resulting in more mistakes due to exhaustion. People in favor of longer shifts (read: docs who are long out of training and hospital admins that rely on residents as some of their most cost-effective man-hours) argue this shows that shorter shifts do not provide patient benefit, so fuck it. Those in favor of shorter shifts (read: pretty much everyone else) argue that if it's all equal for patients, we shouldn't be torturing residents (they're people, too), and that what this really shows is that the hand-off process is shit and needs to be improved upon. More sleep and better hand-offs are the road to better patient outcomes and happier (or at least sane) residents. And it's worth noting that the fight for sane hours has, thus far, only extended to first-year residents. Second+ are still dogmeat. ...and that's the literature position. From first-hand experience, though, I can tell you true horror stories. Mistakes due to hand-offs can be reduced; mistakes because one of my colleagues had a dissociative episode during a way-too-long period without sleep is harder to catch. But no one discloses lapses in sanity during these studies.
- yardie 9y ago
  Thank you! I kept hearing this "doctors need to be on call 30+ ,40+, 50+ hours because of handoff issues." Rarely has anyone mentioned they need to fix the handoff issue instead they prefer to keep the status quo.
- mattkrause 9y ago
  You also have to look at the baseline in these papers. Many of these studies do daft things like compare 24 and 28 hour shifts, neither of which is likely to be anywhere near optimal performance. Hand-off also seems like a thing that could be improved in many different ways, while fatigue is driven by fundamental limits of human physiology.
  - logfromblammo 9y ago
    Seems like a patient handoff/briefing is something technology could improve, with automatically generated digests, AI-flagged indications, and well-designed infographics, whereas no machine on Earth is currently capable of getting 8 hours of sleep for you.
    - arkades 9y ago
      Technology doesn't help because many of the issues that are "lost" in handoffs exist only in a physician's head. And since digital documentation is both (1) incredibly inconvenient and (2) a legal liability, it's likely to stay there. The issue with hand-offs comes down to trying to transfer too much information, too quickly. Fixing this is primarily a funding issue - everything else is trying to make up a fundamental resource scarcity with operational improvements.
- xapata 9y ago
  It's amazing what a human can do while effectively sleepwalking. Life tip: (politely) ask how long your doctor has been awake, perhaps disguising the question as how long the shift has been.
  - arkades 9y ago
    Yeah, we know this one. No, we will not tell you we've been up for 28 hours. It creates issues, both of the liability type and the shifting-work-unto-your-coworkers type. If you don't want an exhausted doc, you have to tackle it at the policy level. There are advocacy groups working on this, and the proper targets are your legislators and state medical societies.
    - cyamaneuvers 9y ago
      patients are similarly well aware that doctors will lie to us to cover their ass. possibly why so many of us resent paying you exorbitant sums to do poor work?
      - arkades 9y ago
        Leaving aside he topic of money, as I've no intention of going down that rabbit hole of bs: People have no idea what the quality of our work is: bad, good, or in-between. You have neither the expertise nor the information by which to judge. The Chief Quality Officer (and former anesthesiologist) at (major academic medical center) once told me, "I have access to more quality data than absolutely anyone else in this hospital ... and I still have no idea who the good surgeons are and who the bad ones are. I haven't known that since I left working in the operating room every day, when I actually saw them all work day after day." What he doesn't know, you certainly do not. You know all those posts here about how managers have unrealistic expectations, and constantly misunderstand what software devs actually do? It's like that, only moreso.
lostlogin 9y ago
That’s an abysmal rate with either system - nearly 1 in 10. I assume that hospital does some fairly heroic things, but a quick google didn’t reveal anything special.

arkades 9y ago

What the literature consensus largely shows is that there's a roughly equal swap between more sleep/shorter hours resulting in more mistakes due to hand-offs, and longer shifts resulting in more mistakes due to exhaustion. People in favor of longer shifts (read: docs who are long out of training and hospital admins that rely on residents as some of their most cost-effective man-hours) argue this shows that shorter shifts do not provide patient benefit, so fuck it. Those in favor of shorter shifts (read: pretty much everyone else) argue that if it's all equal for patients, we shouldn't be torturing residents (they're people, too), and that what this really shows is that the hand-off process is shit and needs to be improved upon. More sleep and better hand-offs are the road to better patient outcomes and happier (or at least sane) residents. And it's worth noting that the fight for sane hours has, thus far, only extended to first-year residents. Second+ are still dogmeat. ...and that's the literature position. From first-hand experience, though, I can tell you true horror stories. Mistakes due to hand-offs can be reduced; mistakes because one of my colleagues had a dissociative episode during a way-too-long period without sleep is harder to catch. But no one discloses lapses in sanity during these studies.

yardie 9y ago
Thank you! I kept hearing this "doctors need to be on call 30+ ,40+, 50+ hours because of handoff issues." Rarely has anyone mentioned they need to fix the handoff issue instead they prefer to keep the status quo.
mattkrause 9y ago
You also have to look at the baseline in these papers. Many of these studies do daft things like compare 24 and 28 hour shifts, neither of which is likely to be anywhere near optimal performance. Hand-off also seems like a thing that could be improved in many different ways, while fatigue is driven by fundamental limits of human physiology.
- logfromblammo 9y ago
  Seems like a patient handoff/briefing is something technology could improve, with automatically generated digests, AI-flagged indications, and well-designed infographics, whereas no machine on Earth is currently capable of getting 8 hours of sleep for you.
  - arkades 9y ago
    Technology doesn't help because many of the issues that are "lost" in handoffs exist only in a physician's head. And since digital documentation is both (1) incredibly inconvenient and (2) a legal liability, it's likely to stay there. The issue with hand-offs comes down to trying to transfer too much information, too quickly. Fixing this is primarily a funding issue - everything else is trying to make up a fundamental resource scarcity with operational improvements.
xapata 9y ago
It's amazing what a human can do while effectively sleepwalking. Life tip: (politely) ask how long your doctor has been awake, perhaps disguising the question as how long the shift has been.
- arkades 9y ago
  Yeah, we know this one. No, we will not tell you we've been up for 28 hours. It creates issues, both of the liability type and the shifting-work-unto-your-coworkers type. If you don't want an exhausted doc, you have to tackle it at the policy level. There are advocacy groups working on this, and the proper targets are your legislators and state medical societies.
  - cyamaneuvers 9y ago
    patients are similarly well aware that doctors will lie to us to cover their ass. possibly why so many of us resent paying you exorbitant sums to do poor work?
    - arkades 9y ago
      Leaving aside he topic of money, as I've no intention of going down that rabbit hole of bs: People have no idea what the quality of our work is: bad, good, or in-between. You have neither the expertise nor the information by which to judge. The Chief Quality Officer (and former anesthesiologist) at (major academic medical center) once told me, "I have access to more quality data than absolutely anyone else in this hospital ... and I still have no idea who the good surgeons are and who the bad ones are. I haven't known that since I left working in the operating room every day, when I actually saw them all work day after day." What he doesn't know, you certainly do not. You know all those posts here about how managers have unrealistic expectations, and constantly misunderstand what software devs actually do? It's like that, only moreso.

lostlogin 9y ago

That’s an abysmal rate with either system - nearly 1 in 10. I assume that hospital does some fairly heroic things, but a quick google didn’t reveal anything special.